A pessary is a soft, removable medical device inserted into the vagina to provide non-surgical support for pelvic organs. Often made of silicone, this device manages symptoms related to pelvic organ prolapse, which occurs when organs like the bladder or uterus descend from their normal position. Pessaries also support the urethra to alleviate stress urinary incontinence, reducing accidental leakage during activities like coughing or exercise. While the initial fitting is done by a healthcare provider, many individuals learn to manage the device independently at home, involving regular removal, cleaning, and re-insertion to maintain hygiene and effectiveness.
Preparing for Self-Insertion
Before beginning the insertion process, confirm that the pessary is the correct type and size as determined by a healthcare professional. Start by thoroughly washing your hands with soap and water to prevent the introduction of bacteria into the vaginal canal. The pessary itself should also be cleaned and dried before reinsertion.
Gathering the necessary supplies involves obtaining a water-based lubricant, which is recommended because oil-based products can degrade the silicone material of the pessary. Apply a small amount of this lubricant to the leading edge of the pessary and the entrance of the vagina to ensure a smooth, comfortable insertion. Finding a comfortable body position is also helpful, with options including lying down with knees bent, standing with one foot elevated on a stool, or adopting a deep squat.
Step-by-Step Insertion Technique
The physical maneuver begins by folding the pessary to make its insertion easier, often into a narrow “taco” or “figure-eight” shape, particularly with ring-style devices. Some pessaries, like the cube, are simply compressed between the fingers before being guided into the vagina. Use the non-dominant hand to gently separate the labia, providing a clear path to the vaginal opening.
The lubricated, folded pessary is then inserted, angling it backward and slightly downward, following the natural curve of the vaginal canal. It should be pushed in as far as possible without causing discomfort, allowing the pessary to unfold into its supportive shape once it passes the vaginal entrance. For ring pessaries, the goal is to guide the rim past the pubic bone, ensuring the device rests high within the vagina.
After the pessary is released, use an index finger to verify that the device is correctly positioned, sitting high enough that it is no longer felt. A properly placed pessary should immediately alleviate the symptoms it is intended to treat, such as the sensation of prolapse or urinary leakage. If the device feels uncomfortable or is easily felt low in the vagina, it may need to be gently pushed further back until it settles into a more secure, symptom-relieving position.
Removal, Cleaning, and Maintenance
The self-management cycle requires regular removal for cleaning, with the frequency depending on the pessary type and the doctor’s instructions, ranging from daily to weekly. To remove the device, assume a comfortable position, such as squatting or standing with one foot elevated, and insert a finger to locate the pessary’s rim. For ring pessaries, hook a finger under the edge and gently pull down and out, sometimes while bearing down slightly to ease the process.
For cube pessaries, which use suction, it is necessary to sweep a finger around the edge to break the seal before gently pulling it down. After removal, the device should be immediately cleaned using mild soap and warm water, avoiding harsh chemicals or scented soaps that can cause vaginal irritation. The pessary must be thoroughly rinsed to remove all soap residue, paying special attention to any grooves or textured areas.
After cleaning, the pessary should be completely dried before being reinserted or stored in a clean, non-airtight container. Following this maintenance schedule prevents the buildup of residue and reduces the risk of irritation or infection within the vagina. Some individuals with a removable pessary choose to leave the device out overnight once a week to give the vaginal tissues a rest.
Recognizing Issues and Seeking Guidance
While a correctly fitted pessary should not cause pain, minor discomfort can sometimes occur during the initial adjustment period or if the device shifts. Difficulty with insertion or removal, despite using proper technique, is an indication that the fit may be incorrect or that guidance from a healthcare provider is needed. If the pessary frequently feels loose, slips out during physical activity, or fails to relieve the original symptoms, it likely requires a refitting.
Certain signs suggest the need for prompt medical attention, including any persistent or worsening pain while the device is in place. Pink or bloody discharge is a sign that the pessary may be rubbing against the vaginal wall, which can lead to irritation or ulceration. Additionally, an increase in foul-smelling or discolored vaginal discharge may signal an infection, such as bacterial vaginosis, which requires medical treatment.