Does a Pessary Hurt? When to Be Concerned About Pain

Most people experience some pressure or mild discomfort when a pessary is first placed, but it should not cause significant pain once it is properly fitted and settled. In a study of over 200 women, the average pain score during insertion was about 2.7 out of 10, which is closer to “aware of it” than “it hurts.” Sharp, persistent, or worsening pain after the initial fitting period is not normal and typically means something needs to change, whether that is the size, the type of pessary, or something happening with the vaginal tissue underneath it.

What Insertion and Removal Actually Feel Like

If you have ever had a pelvic exam, the sensation of having a pessary inserted is roughly in the same territory. A service evaluation of 213 women found that insertion pain averaged 2.66 on a 0-to-10 scale, with a median of 2. Removal scored higher, averaging 4.37 with a median of 4. About 58% of women said removal was more painful than insertion, while only about 11% found insertion worse.¹ These are averages, though, and they mask a wide range. Some women barely noticed anything; others found removal genuinely uncomfortable, especially with certain pessary types.

The type of pessary made a clear difference. Ring pessaries were significantly less painful to insert and remove than shelf or Gellhorn designs, which are bulkier and have a more rigid profile.¹ This matters because you might assume a smaller device would be gentler. Counterintuitively, the same study found smaller pessaries were actually more painful to insert and remove than larger ones. A pessary that is slightly too small may shift around more, creating friction and requiring more manipulation to get in and out. A well-fitting pessary sits snugly enough that it does not need much adjusting.

Why Pessary Type and Fit Change the Pain Picture

Pessaries come in a range of shapes, from simple flexible rings to Gellhorn designs with a stem and disc, to cube pessaries that grip the vaginal walls with suction. The ring is the most commonly tried first because it is the least intrusive and the easiest to insert and remove. Gellhorn and cube designs are usually reserved for more advanced prolapse where a ring cannot stay in place. A retrospective study spanning eight years found that difficulty inserting or removing the pessary was the single most common reason patients abandoned use, accounting for about 30% of discontinuation reasons.² Erosions were the second most common factor, at about 23%.

Fitting is somewhat trial-and-error. Your clinician selects a size based on a vaginal exam, but the right fit often takes one or two return visits to fine-tune. A pessary that is too large presses against the vaginal walls with excessive force, which can cause pressure pain, difficulty urinating, or trouble with bowel movements. One that is too small tends to slip, rub, and generally feel more irritating even though you might expect the opposite. The goal is a pessary that you cannot feel during normal activity. If you are constantly aware of it, or if it causes a dragging or pinching sensation, the size or shape likely needs adjustment.

Common Causes of Ongoing Discomfort

Once a pessary is fitted well, it typically fades into the background. When it does not, the cause usually falls into a few categories.

Vaginal erosion: The most frequently reported complication. The pessary sits against the vaginal mucosa, and over time it can cause superficial wearing of the tissue. Erosions were found in about 24% of patients in a long-term retrospective study.² These areas can sting or burn, especially with movement or during pessary changes.
Increased discharge: Pessary users tend to have more vaginal discharge, itching, and occasionally genital ulcers compared to women with prolapse who do not use a pessary.³ The extra discharge is often related to the physical presence of the device rather than an infection that needs antibiotics, but it can feel uncomfortable and raise alarm.
Abnormal bleeding: Reported in roughly 10% of pessary users, this is often linked to erosion or tissue irritation rather than a separate problem.²
General discomfort: Among women who ultimately stopped using a pessary, “it was uncomfortable” was tied as the most common reason, cited by about 22% of those who quit.⁴

Erosion deserves a closer look because it is so common. The tissue breakdown is usually superficial, and it typically heals on its own once the pessary is removed for a period.⁵ Your clinician may suggest a “pessary holiday” of a few days to a few weeks. In postmenopausal women, the vaginal lining is already thinner and drier due to lower estrogen levels, a condition broadly described as vulvovaginal atrophy.⁶ That thinner tissue is more vulnerable to mechanical irritation from the pessary, which is one reason erosion rates tend to be higher in older users.

When Pain Signals Something Serious

Mild pressure that fades over a day or two after a fitting is unremarkable. A dull awareness during heavy lifting or at the end of a long day may just mean the pessary has shifted slightly. But there are pain patterns that warrant prompt attention.

Persistent erosions that do not heal can progress to deeper ulcerations. If an ulcer develops and is left unaddressed, it can erode through the vaginal wall and into adjacent structures, potentially creating a fistula, an abnormal connection between the vagina and the bladder or rectum. Fistulas are rare but documented. A case report describes a 70-year-old woman whose neglected Gellhorn pessary became impacted and eventually eroded into the rectum, requiring removal under anesthesia and leaving a large rectovaginal fistula.⁷ Cases like this virtually always involve pessaries that were left in place far too long without any follow-up care.

Erosions and ulcerations can also cause the vaginal tissue to form adhesions around the pessary, effectively trapping it in place.⁸ A trapped pessary is painful, difficult to remove in a clinic, and sometimes requires a procedure under sedation. The common thread in serious complications is neglect. A pessary that is checked and cleaned on a regular schedule almost never reaches these stages.

You should contact your provider if you experience any of the following: pain that increases over days rather than subsiding, new bleeding that is not explained by a known erosion being managed, foul-smelling discharge (which can indicate infection or tissue breakdown), difficulty urinating or having a bowel movement that was not present before, or an inability to remove or reposition the pessary yourself if you practice self-management. Serious complications from pessaries are rare, but vesicovaginal fistula, rectovaginal fistula, erosion, and impaction have all been reported in the literature.⁹

Does Vaginal Estrogen Reduce Pain?

Clinicians frequently prescribe vaginal estrogen cream alongside a pessary, especially for postmenopausal women, with the rationale that plumping up the vaginal tissue will reduce erosion and make the pessary more comfortable. The evidence on this is more nuanced than you might expect. A study tracking pessary users over time found that vaginal estrogen did not significantly reduce erosion rates or vaginal bleeding. The erosion rate was actually slightly higher in the estrogen group (about 37%) than in those not using it (about 28%), though the difference was not statistically meaningful.¹⁰

Where estrogen did make a measurable difference was in two other areas. Women using vaginal estrogen were significantly less likely to develop increased vaginal discharge, with about 16% affected compared to 32% in the non-estrogen group. And only about 2% of estrogen users cited pain as their primary reason for stopping pessary use, compared to about 18% of those not using estrogen.¹⁰ So while estrogen may not prevent the visible tissue changes, it seems to affect overall comfort and the likelihood of sticking with the pessary long-term. The mechanism is not entirely clear from this study alone, but it may relate to improved tissue hydration and flexibility even when erosion still occurs at a similar rate.

Self-Management and Its Effect on Complications

Traditionally, pessary care meant returning to a clinic every few months to have a nurse or doctor remove it, clean it, inspect the vaginal walls, and reinsert it. More recently, many clinicians are teaching patients to handle this themselves, removing the pessary at home, washing it, and reinserting it on a regular schedule.

A randomized controlled trial comparing self-management to clinic-based care over 18 months found that women who managed their own pessaries reported a lower rate of complications overall.¹¹ A separate study found that self-care users had fewer vaginal erosions and fewer office visits than those relying on clinic-based management, with no difference in how long they continued using the pessary.¹²

This makes intuitive sense. If you can take your pessary out nightly or every few days, you give the vaginal tissue a regular break from pressure. You also notice changes, like new discharge, bleeding, or a sore spot, earlier than you would if the device sat untouched between quarterly clinic visits. Not everyone is a good candidate for self-management. Some pessary types, like the Gellhorn and cube, are harder to insert and remove without practice, and some women find the process physically difficult due to limited hand mobility or discomfort reaching the device. But for those who can manage it, the pain and complication data favor doing so.

Sex With a Pessary

A common worry is whether a pessary will make intercourse painful, either for you or your partner. The answer depends heavily on the type of pessary. Ring pessaries and some other flat designs can technically stay in during vaginal intercourse, and for many women and their partners, the device is not noticeable.¹³ Bulkier designs like the Gellhorn, cube, or doughnut pessary physically occupy too much space for comfortable intercourse and need to be removed beforehand.¹⁴

Many women choose to remove even a ring pessary before sex and reinsert it afterward. If this is something that matters to you, it is worth discussing with your clinician before the fitting, since it may influence which type of pessary is selected. A pessary that works well for prolapse support but requires a clinic visit for removal every time you want to have sex is not going to serve you well in practice. Self-management training becomes especially valuable here, because it gives you the freedom to remove and replace the device on your own schedule.

If you or your partner notices discomfort during intercourse that was not there before the pessary, it does not necessarily mean the pessary is the wrong choice. It may mean the fit needs adjusting, or that the pessary type should be reconsidered. Sometimes the prolapse itself was masking pre-existing discomfort, and supporting the pelvic organs changes the anatomy just enough to reveal it. This is worth a conversation with your provider rather than a reason to abandon the device altogether.

What the Vaginal Tissue Itself Feels

One reason pessaries are tolerable for most people is that the vagina is not uniformly sensitive in the way, say, your fingertips are. A study mapping nerve distribution across the vaginal wall found that nerve density was fairly regular throughout, with no single site consistently demonstrating the highest concentration of nerves.¹⁵ The vaginal canal has enough sensory innervation that you can feel pressure and stretching, but the deeper portions where a pessary typically sits are less acutely sensitive than the vaginal opening. This is why insertion and removal, which involve the narrower and more nerve-rich introitus, tend to be the most uncomfortable moments, while the pessary sitting in place deeper inside is often barely perceptible.

For postmenopausal women, the tissue changes from reduced estrogen can shift this balance. Thinner, drier vaginal walls are more prone to irritation from any contact, including a pessary. The introitus can become particularly tender, making even the passage of a well-fitted ring uncomfortable. This is one reason why vaginal estrogen or a water-based lubricant applied during insertion is commonly recommended, even though the data on estrogen preventing erosion specifically is not as strong as many clinicians assume.

Materials and Allergic Reactions

Modern pessaries are almost universally made from medical-grade silicone, which is biocompatible and causes allergic reactions very rarely. Older pessaries were sometimes made from rubber or other materials with higher allergy potential. Some polyvinyl chloride (PVC) ring pessaries are still in use in certain healthcare systems. A randomized trial comparing a silicone pessary to a PVC ring pessary found no significant differences in satisfaction, quality-of-life scores, or treatment complications between the two materials.¹⁶ Allergic reactions to pessary materials were reported in only about 0.5% of patients in the eight-year retrospective study mentioned earlier.² If you have a known silicone or latex sensitivity, mention it before fitting so your clinician can choose an appropriate material, but for the vast majority of users this is a non-issue.

What can feel like a material reaction is sometimes actually a response to the lubricant used during insertion, or to a cleaning product used on the pessary. Water-based lubricants without fragrance or additives are safest. Some women clean their pessary with soap that leaves a residue, which can cause burning or itching on reinsertion. Rinsing with plain water is generally sufficient between uses, with mild unscented soap used occasionally.

1
PubMed. Patient experience of pain during vaginal pessary removal and insertion: a service evaluation study
2
PubMed Central. Ring and Gellhorn pessaries used in patients with pelvic organ prolapse: a retrospective study of 8 years
3
PubMed Central. Can the Pessary Use Modify the Vaginal Microbiological Flora? A Cross-sectional Study
4
PubMed Central. Pelvic floor symptom changes in pessary users
5
PubMed. Complications of Pessary Use
6
PubMed. Where does postmenopausal dyspareunia hurt? A cross-sectional report
7
PubMed. Neglected pessary causing a rectovaginal fistula: a case report
8
PubMed Central. Complications of Pessaries Amenable to Surgical Correction: Two Case Reports and a Systematic Review of the Literature
9
PubMed Central. Pessary Use in Pelvic Organ Prolapse and Urinary Incontinence
10
PubMed Central. Effect of vaginal estrogen on pessary use
11
eClinicalMedicine. Clinical effectiveness of vaginal pessary self-management vs clinic-based care for pelvic organ prolapse (TOPSY): a randomised controlled superiority trial
12
PubMed. Self-care Pessary Management and Factors Associated With Long-Term Pessary Use
13
PubMed. Vaginal Pessaries for Pelvic Organ Prolapse and Their Impact on Sexual Function
14
PubMed Central. Sexual Function and Pessary Management Among Women Using a Pessary for Pelvic Floor Disorders
15
The Journal of Sexual Medicine. A Prospective Study Examining the Anatomic Distribution of Nerve Density in the Human Vagina
16
PubMed Central. Silicone Irregular Hexagon Pessary Versus Polyvinyl Chloride Ring Pessary for Pelvic Organ Prolapse: Randomised Controlled Trial