Pessaries can contribute to urinary tract infections, though the risk is lower than many users fear. In a randomized trial comparing pessary use with surgery for pelvic organ prolapse, only about 2% of pessary users developed a UTI over the follow-up period. The connection between pessaries and UTIs involves changes to the vaginal environment, biofilm buildup on the device, and shifts in local bacteria, all of which are modifiable with the right care habits.
Why a Pessary Can Set the Stage for Infection
A pessary sits inside the vagina, pressing against the vaginal walls and, depending on its shape and size, sometimes resting near the urethra or bladder base. That constant physical presence does a few things that can nudge the risk of urinary infection upward. The device creates a surface where bacteria can attach and multiply, forming what scientists call a biofilm. One study that examined 40 ring pessaries under electron microscopy confirmed biofilm formation on every single device. The bacterial communities living in those biofilms varied: about 40% were dominated by Lactobacillus (the “friendly” bacteria that normally protect the vagina), while 60% were dominated by other organisms, including anaerobic bacteria that are more likely to cause trouble.1PubMed. Bacterial biofilm formation on vaginal ring pessaries used for pelvic organ prolapse
Beyond the device surface itself, wearing a pessary changes the broader vaginal environment. A pilot study of pessary users found that women who developed vaginal erosions had significantly more alkaline vaginal pH compared to those without erosions. Their vaginal microbiota also shifted: Lactobacillus counts dropped while gram-negative bacteria (the kind commonly implicated in UTIs) increased.2PubMed. Pathophysiology of Vaginal Erosions in Women Using Pessary: A Pilot Study Examining Vaginal Microbiota That shift matters because Lactobacillus bacteria produce lactic acid and hydrogen peroxide, which keep harmful organisms in check. When their numbers fall, the vaginal lining becomes more hospitable to the kinds of bacteria that can migrate to the urethra and cause a UTI.
Mechanical factors play a role too. A pessary that fits poorly or presses against the urethra can interfere with complete bladder emptying. Residual urine left in the bladder after voiding is a well-known risk factor for UTIs because it gives bacteria time and nutrients to multiply. This is not unique to pessary use, but it is one of the mechanisms that can link the device to urinary infections.
How Common Are UTIs Among Pessary Users
The rates reported in research are reassuringly low, especially when pessaries are used for pelvic organ prolapse in non-pregnant adults. In a large randomized trial published in JAMA, UTIs occurred in about 2.3% of women assigned to pessary treatment for symptomatic prolapse, compared to 9% in the group that had surgery.3JAMA. Effect of Pessary vs Surgery on Patient-Reported Improvement in Patients With Symptomatic Pelvic Organ Prolapse That comparison is striking: the pessary group had roughly one-quarter the UTI rate of the surgical group. Surgery involves catheterization, anesthesia, and tissue disruption, all of which carry their own infection risks. So while a pessary is not infection-free, it compares favorably to the main alternative.
UTI rates differ when pessaries are used in other contexts. In a cohort study of pregnant women fitted with cervical pessaries to prevent preterm birth, UTIs were reported in about 5.8% of participants.4PubMed. Cervical pessary for preterm-birth prevention among pregnant women with a short cervix: A prospective cohort study Pregnancy itself changes immune function and the vaginal microbiome, which likely explains the somewhat higher rate. The overall pattern across studies, though, is that UTIs are a recognized but uncommon complication of pessary use.
Vaginal Discharge Is Not the Same Thing as a UTI
One source of confusion is that vaginal discharge is the single most common side effect of wearing a pessary, and many women worry that discharge means infection. A review of complications in women using pessaries for stress urinary incontinence found that discharge was the most frequently reported issue, yet most cases did not involve a true infection.5PubMed Central. Pessary use in stress urinary incontinence: a review of advantages, complications, patient satisfaction, and quality of life A foreign body in the vagina naturally increases mucus production as the tissue reacts to the device. This discharge is typically clear or white, mild in odor, and not accompanied by burning, fever, or pelvic pain.
Discharge that becomes foul-smelling, green or yellow, or is accompanied by irritation and pain warrants a clinical visit, because those features can signal bacterial vaginosis or an actual vaginal infection, which is distinct from a UTI but can coexist with one. UTI-specific symptoms, including burning with urination, urgency, frequency, and cloudy or bloody urine, are the more reliable indicators of a urinary infection. Learning to distinguish normal pessary-related discharge from signs of infection helps avoid unnecessary antibiotic courses and unnecessary anxiety.
The Broader Complication Picture
UTIs make up only a small slice of the side effects that pessary users encounter. A long-term follow-up study of 273 women fitted with ring pessaries found that among 167 women who were still using the device at four weeks, 56% eventually experienced at least one complication. The most common, in descending order, were bleeding, extrusion (the pessary slipping out), severe vaginal discharge, pain, and constipation. Nearly a quarter of those women dealt with more than one type of complication, and many had recurring episodes.6PubMed. Long-term vaginal ring pessary use: discontinuation rates and adverse events By the end of the study, only 14% were still using their pessary.
A narrative review published in 2025 echoed this picture, noting that complications including vaginal discharge, erosion, and bleeding are common but generally manageable with appropriate follow-up.7PubMed Central. Updates in Pessary Care for Pelvic Organ Prolapse: A Narrative Review Vaginal erosion, where the tissue becomes raw or ulcerated under the pressure of the device, is particularly relevant to UTI risk. Erosion disrupts the mucosal barrier and is associated with the same microbiome shifts (more gram-negative bacteria, fewer lactobacilli) that make urinary infections more likely.2PubMed. Pathophysiology of Vaginal Erosions in Women Using Pessary: A Pilot Study Examining Vaginal Microbiota In that sense, preventing erosion and preventing UTIs share a common strategy.
How to Reduce UTI Risk While Using a Pessary
The evidence points to several practical steps that can lower UTI risk for pessary users. None of them are complicated, but they work best in combination.
- Proper fit: A pessary that is too large presses harder against vaginal tissue and the urethra, increasing the chance of erosion and incomplete bladder emptying. One that is too small may shift and cause friction. The fitting process usually involves trying a few sizes, and it is worth going back for a re-fitting if you notice new pressure, pain, or difficulty urinating.
- Regular removal and cleaning: Biofilms build up over time, and the longer a pessary stays in without cleaning, the more established those bacterial communities become. Some women are taught to remove, wash, and reinsert their pessary themselves, while others return to a clinic every few months for a provider to do it. A trial protocol comparing these two approaches (self-management versus clinic visits roughly every six months) has been designed precisely because the frequency and method of cleaning may affect complication rates.8PubMed Central. Clinical and cost-effectiveness of vaginal pessary self-management compared to clinic-based care for pelvic organ prolapse
- Vaginal estrogen: For postmenopausal women, the vaginal lining thins and becomes more fragile after estrogen levels drop. Topical vaginal estrogen, applied as a cream, tablet, or ring, helps restore tissue thickness and supports Lactobacillus growth. Many clinicians prescribe it routinely alongside a pessary. Its benefits for reducing vaginal erosion are well documented, and healthier vaginal tissue is more resistant to both erosion and infection.
- Hydration and voiding habits: Drinking enough water and urinating regularly, rather than holding it for extended periods, helps flush bacteria from the urinary tract. This advice applies whether or not you use a pessary, but it becomes more important when a device may be affecting how completely you empty your bladder.
If you notice that your urine stream feels weaker or that you feel like you cannot quite finish urinating, mention it at your next visit. A slight pessary adjustment can sometimes resolve incomplete emptying and remove a major UTI trigger.
Probiotics and Cranberry Supplements
There is growing interest in whether oral supplements can reduce UTI recurrence, and some of this research is directly relevant to pessary users. A controlled pilot study tested a combination of probiotics and cranberry extract in premenopausal women prone to recurrent UTIs. After 26 weeks, about 9% of women taking the supplement experienced a recurrent UTI, compared to a third of those on placebo. The supplement group also went longer before their first UTI (around 174 days versus 90 days for placebo) and needed fewer courses of antibiotics.9Taylor & Francis Online / Expert Review of Anti-infective Therapy. Probiotic and cranberry supplementation for preventing recurrent uncomplicated urinary tract infections in premenopausal women: a controlled pilot study
This study was not conducted specifically in pessary users, so you cannot assume the same effect sizes translate directly. But the logic holds up: if the pessary’s main contribution to UTI risk is disrupting the vaginal microbiome and allowing gram-negative bacteria to flourish, then interventions that restore Lactobacillus dominance and make the urinary tract less hospitable to pathogens should help. Probiotics containing Lactobacillus strains (particularly L. rhamnosus and L. reuteri, the strains most studied for urogenital health) are worth discussing with your provider, especially if you have had even one UTI while using a pessary. Cranberry products, whether as juice or concentrated capsules, contain compounds called proanthocyanidins that interfere with bacterial adhesion to the bladder wall. Neither approach is a guarantee, but they add a layer of protection without the downsides of prophylactic antibiotics.
Self-Management Versus Clinic Visits
How you manage your pessary day to day matters for infection risk. There are broadly two camps: women who learn to remove, clean, and reinsert the device themselves, and women who leave the pessary in place continuously and visit a healthcare provider periodically for removal and maintenance. The self-management approach allows more frequent cleaning, which should in theory reduce biofilm accumulation and lower infection risk. The clinic-based approach means the device may stay in place for weeks or months between cleanings, which gives biofilms more time to mature.
The trade-off is not purely about cleanliness, though. Some women find self-management stressful, particularly early on, and improper removal or reinsertion can cause tissue trauma. A large randomized trial comparing the two strategies has been designed to determine whether self-management actually produces better outcomes, including fewer infections and lower costs.8PubMed Central. Clinical and cost-effectiveness of vaginal pessary self-management compared to clinic-based care for pelvic organ prolapse Until that trial reports results, the best approach depends on your comfort level, dexterity, and access to clinical support. If you can learn to do it confidently, more frequent cleaning is almost certainly better for your vaginal and urinary health. If you prefer clinic visits, scheduling them at shorter intervals (every three to four months rather than every six) is a reasonable compromise.
Cervical Pessaries in Pregnancy
Most of the discussion so far applies to pessaries used for pelvic organ prolapse or incontinence, which are typically ring, donut, or Gellhorn shapes worn by non-pregnant adults. But a different type of pessary, the cervical pessary (often an Arabin device), is used during pregnancy to reduce the risk of preterm birth in women with a short cervix. The UTI concern applies here too, though the context is different.
In the prospective cohort study mentioned earlier, about 5.8% of pregnant women wearing a cervical pessary developed a UTI, while vaginal discharge affected nearly 30% and fungal vaginitis about 9%.4PubMed. Cervical pessary for preterm-birth prevention among pregnant women with a short cervix: A prospective cohort study UTIs during pregnancy carry higher stakes because they can trigger preterm labor and harm the baby, so even a modest rate warrants attention. A separate randomized trial of cervical pessaries in symptomatic pregnant women listed UTI among the tracked side effects, alongside vaginal discharge, pessary descent, and pelvic pain.10Journal of Obstetrics, Gynecology and Cancer Research. Efficacy and Safety of Cervical Pessary in Decreasing the Preterm Labor in Symptomatic Pregnant Women
Pregnant women using a cervical pessary generally cannot remove and clean the device themselves; the pessary is placed by a provider and left in position until a target gestational age. This means the biofilm accumulation pathway is largely unavoidable, and the main preventive strategies shift to monitoring urine cultures at regular prenatal visits, treating any asymptomatic bacteriuria promptly, and maintaining good hydration. If you are pregnant and wearing a cervical pessary, reporting any urinary symptoms immediately rather than waiting for the next scheduled visit is important, because early treatment prevents complications for both you and the baby.
When UTIs Keep Coming Back
For the small percentage of pessary users who get recurrent UTIs, a few questions are worth working through with a provider. The first is whether the pessary fit needs adjusting. A device that has shifted, or one that was marginal in size from the start, can create new pressure points or worsen bladder emptying over time. Bodies change, especially after menopause, and a pessary that fit well two years ago may not fit well today.
The second question is whether there is an underlying vaginal erosion. Since erosion and UTI risk share similar microbiome disruptions, treating one often helps the other. Vaginal estrogen can address both simultaneously in postmenopausal women by restoring tissue thickness and supporting healthy bacterial populations.
The third question is whether the pessary is still the best option. For most women, the answer is yes: the UTI rate with pessaries is lower than with surgery, the device is reversible, and it avoids the risks of anesthesia and operative recovery. But if a pessary is causing repeated infections that antibiotics cannot keep up with, and conservative measures have been tried, a conversation about surgical alternatives or a different pessary type is reasonable. Some pessary shapes sit differently relative to the urethra, and switching from one type to another sometimes resolves the problem without abandoning the approach entirely.
There is no single threshold of UTIs that means you should stop using a pessary. Two infections in six months might simply mean you need more frequent cleaning or a size adjustment. The same two infections after optimizing every modifiable factor tell a different story. The decision is always individual, weighed against how much the pessary improves your quality of life in other ways.