A pessary is a removable, supportive device, typically made of medical-grade silicone, that is placed inside the vagina to manage the symptoms of pelvic organ prolapse. This condition occurs when the uterus, bladder, or rectum descends from its normal position due to weakened pelvic floor support. By acting as an internal brace, the pessary holds the pelvic organs in their correct anatomical position, which helps alleviate feelings of pressure or bulging and may improve urinary or bowel symptoms. For individuals instructed by their healthcare provider to manage their pessary at home, understanding the proper technique for insertion and removal is important for both comfort and effectiveness.
Preparing for Insertion
Before beginning the insertion process, you should gather all necessary materials and ensure a clean environment to minimize the risk of infection. Start by thoroughly washing your hands with soap and warm water, and clean the pessary itself with mild soap and water, then rinse and dry it completely. Next, apply a generous amount of water-based lubricant, such as a product containing glycerin or propylene glycol, to the pessary to help it glide easily into the vaginal canal.
Finding a comfortable and effective body position is a personal process that may require some initial experimentation. Many find it easiest to insert the device while lying on their back with knees bent and hips slightly apart, or by standing with one foot raised on a stable surface like a chair or the edge of a bed. Squatting can also be an effective position for some individuals, as it naturally shortens the vaginal canal. Once positioned, take a moment to relax your pelvic floor muscles, as tension can make the insertion process more difficult.
Finally, inspect the pessary for any signs of wear, such as cracks, tears, or sharp edges, before attempting to insert it. A damaged pessary should not be used and must be replaced to prevent irritation or injury to the delicate vaginal tissues. You should also ensure you have the correct type and size that was prescribed by your healthcare provider, as a device that is too small may fall out, and one that is too large can cause discomfort.
Step-by-Step Insertion Guide
The physical insertion process begins by preparing the pessary to fit through the vaginal opening, which typically involves folding or compressing the device. For common ring pessaries, you should fold the device in half, creating a narrow, vertical shape similar to a taco or a figure eight, which significantly reduces its diameter for entry. If you are using a cube pessary, you will simply compress the soft silicone material between your thumb and forefinger.
With the pessary folded, use your non-dominant hand to gently separate the labia, exposing the vaginal opening. Then, hold the folded pessary with the lubricated, leading edge pointing inward and upward, aiming it toward the small of your back. This downward and backward angle follows the natural curve of the vaginal canal, facilitating a smoother insertion. Gently push the pessary into the vagina, guiding it as far back as you comfortably can.
Once the pessary is fully inside the canal, release your grip, allowing the flexible device to spring back into its supportive shape. Use your index finger to check the final placement, ensuring the rim sits comfortably behind the pubic bone. A correctly placed ring pessary should rest high in the vagina without causing noticeable pressure or discomfort. If the insertion feels uncomfortable or the device does not seat properly, remove it, relax, apply more lubricant, and attempt the process again.
Removing and Cleaning the Device
Removing the pessary requires a gentle and controlled technique to avoid irritation, and you should use the same comfortable position you used for insertion. Begin by washing your hands thoroughly to maintain hygiene before touching the device. Insert one or two fingers into the vagina until you locate the rim of the pessary, which is typically found just under the pubic bone.
Once you locate the rim, hook your index finger under the edge or through the center opening of the ring pessary. If you are using a cube pessary, you may need to sweep a finger around the edge to break the suction seal before gently pulling it down. Apply a steady, gentle pull, tilting the pessary slightly downward and outward to ease it through the vaginal opening. Some individuals find that bearing down, as if having a bowel movement, can help push the rim forward and make it easier to grasp.
Immediately after removal, the device should be cleaned to prevent bacterial growth and maintain the health of the vaginal tissue. Wash the pessary with mild, non-perfumed soap and warm water, scrubbing the surfaces to remove any discharge. Rinse it completely, ensuring no soap residue remains, and allow it to air-dry thoroughly before reinsertion or storage. The frequency of removal and cleaning is determined by your healthcare provider, but many self-managing users clean their pessaries daily or weekly.
You must contact your doctor if you experience increased pain, unexplained vaginal bleeding, a strong or unusual odor, or if you are unable to remove the device yourself.