Inserting a pessary at home is straightforward once you know the technique, though it can feel awkward the first few times. While we can’t embed a video here, the step-by-step process below mirrors exactly what instructional videos demonstrate, broken into the same visual steps so you can follow along or use this as a reference alongside a video from your provider.
Choose Your Position First
Your body position makes a big difference in how easily the pessary slides in. Most women use one of three positions:
- Standing with one foot elevated: Place your non-dominant foot on a chair, low stool, or toilet seat, and lean forward over that leg. If you’re right-handed, your left foot goes up so your right hand is free to guide the pessary.
- Lying down: Lie on your bed with your knees bent and feet flat. This relaxes the pelvic floor and gives you a clear angle.
- Sitting on the edge of a chair: Scoot forward to the edge with your knees apart. Some women find this the easiest position when they’re still getting comfortable with the process.
Try all three and stick with whichever feels most natural. The goal is to relax your pelvic muscles, so pick the position where you feel least tense.
How to Insert a Ring Pessary
The ring pessary is by far the most common type for self-management, and the one you’ll see in most instructional videos. Here’s the full sequence:
1. Wash your hands and the pessary with mild soap and water. Rinse thoroughly and dry. Apply a small amount of water-based lubricant to the leading edge of the pessary. Avoid oil-based lubricants, which can degrade silicone over time.
2. Fold the pessary. A silicone ring pessary compresses into an oval shape. A vinyl ring pessary folds into a figure-of-eight. The pessary will only fold one way, at the indentation areas built into the ring, so don’t force it in the wrong direction.
3. Part the labia with your non-dominant hand. With your dominant hand, hold the folded pessary lengthwise (like inserting a tampon) and slide it into the vaginal opening as far back as it will comfortably go.
4. Guide it into position. Once the pessary is inside, use the index finger of your other hand to push it further in, angling toward your tailbone (not straight up). The pessary will spring open once you release it.
5. Check the placement. Use your index finger to feel that the rim of the pessary sits behind your pubic bone. You should be able to feel the bone with the pessary tucked just behind it. If you can feel the pessary at the vaginal opening or it’s uncomfortable, push it a bit deeper.
A properly placed ring pessary shouldn’t cause pain, and you generally won’t feel it during normal activities. You should be able to urinate and have bowel movements without difficulty.
Insertion for Gellhorn and Cube Pessaries
Not all pessary types are designed for self-management. The Gellhorn pessary, which looks like a disc with a central stem, is typically used for more advanced prolapse and is harder to insert and remove on your own. Most providers handle Gellhorn fittings and replacements in the office. To insert one, the disc is folded in half with lubricant on the leading edge, then guided past the pubic bone where it expands and creates suction against the prolapsed tissue.
The cube pessary is a flexible silicone block with concave sides that suction to the vaginal walls. To insert it, you compress the cube and slide it in. It has a string attached for removal, similar to a tampon. Cube pessaries are generally reserved for stage III and IV prolapse when other types haven’t worked, and they need to be removed and cleaned daily because vaginal secretions can get trapped in the crevices.
How to Remove a Ring Pessary
Removal is the part most women find intimidating at first. Hook a single finger under the rim of the pessary and gently pull it downward toward your rectum while folding the rim inward. This breaks the light suction seal holding the pessary in place. Keep the pessary folded as you guide it out through the vaginal opening.
If the pessary feels stuck, don’t panic. Bear down gently as if you’re having a bowel movement. This pushes the pessary lower and makes it easier to reach the rim. You can also try squirting a small amount of warm water around the edge to break the suction. The pessary isn’t going anywhere dangerous; it simply has a mild seal that needs to be released.
Cleaning and Daily Care
Each time you remove the pessary, wash it with mild soap and water, rinse it completely, and let it dry before reinserting. Avoid harsh chemicals, antibacterial soaps with strong fragrances, or anything that could irritate vaginal tissue.
How often you remove it depends on your provider’s instructions and your pessary type. Daily removal and reinsertion is common for cube pessaries and has been shown to reduce discharge and inflammation. For ring pessaries, some women remove and clean theirs nightly while others do so every few days. If you self-manage your pessary at home, plan on a check-up visit every 6 to 12 months.
Signs Something Isn’t Right
A mild, watery discharge is normal with pessary use and isn’t a sign of infection. Roughly one-third of pessary users experience some discharge, and on its own it’s nothing to worry about.
What does need attention: foul-smelling discharge, blood-stained or pus-like discharge, itching, burning, or persistent pain. These can signal vaginal mucosal erosion, which is the most common pessary complication. It happens when the pessary creates localized pressure on the vaginal wall over time. Constipation and difficulty urinating can also indicate the pessary has shifted or is the wrong size.
If your pessary repeatedly slides down or falls out during activity, it’s likely too small. If it causes pressure or pain, it may be too large. Either way, sizing adjustments are quick office visits. Most women try one or two sizes before finding the right fit.
Tips That Make It Easier
The learning curve is real. Many women take a few tries before insertion feels routine. A few things that help: use enough lubricant (a water-based product like YES WB or Sylk works well), relax your jaw and shoulders before you start (tension in your upper body tightens your pelvic floor), and give yourself privacy and time rather than rushing. Some women find it helpful to practice removal and reinsertion a few times at their provider’s office before trying at home for the first time.
If vaginal dryness makes insertion uncomfortable, a vaginal moisturizer used regularly between insertions can improve tissue comfort over time. Your provider may also recommend a topical estrogen cream, which helps maintain the vaginal lining and reduces the risk of erosion with long-term pessary use.