How to Insert a Pessary: Step-by-Step Video

Pessary insertion is a skill that most people learn directly from a healthcare provider during an in-office fitting, and no online video can substitute for that hands-on instruction. A pessary is a removable device placed into the vagina to support organs that have shifted out of position, most often used for pelvic organ prolapse and stress urinary incontinence.¹ The reason the internet is full of people searching for step-by-step insertion videos is straightforward: once you’ve been fitted, your clinician usually expects you to handle the device on your own, and that transition from clinic to bathroom mirror can feel intimidating. What follows is everything you need to know about how pessary insertion actually works, what makes it easier, and what to do when something doesn’t feel right.

Why a Fitting Comes First

Before you ever insert a pessary at home, a provider needs to determine which type and size works for your anatomy. Pessaries come in dozens of shapes and sizes, broadly divided into two categories: support types like the ring pessary, and space-occupying types like the Gellhorn. Ring pessaries are typically tried first for mild to moderate prolapse, while Gellhorn pessaries, which create more structural support, tend to be reserved for more advanced cases.² A prospective study of women with stage IV prolapse found that about 45% were successfully fitted with a ring pessary on the first attempt; those who failed with the ring then tried a Gellhorn, and roughly 69% of that group succeeded, bringing the overall fitting success rate to about 83%.³

The fitting visit typically involves the provider inserting several sizes in sequence, asking you to stand, cough, and bear down to see if the device stays in place without causing discomfort. Once the right size is found, the provider should walk you through removal and reinsertion yourself, in the office, before sending you home. This is the moment where hands-on teaching matters most, and it’s the reason a video alone isn’t a reliable substitute: your pessary type, your pelvic anatomy, and the angle that works for you are all specific to your body.

General Insertion Steps for Ring-Style Pessaries

Ring pessaries are the easiest type to insert and remove at home, which is one reason they’re tried first. The general process most clinicians teach goes something like this:

Wash your hands thoroughly with soap and water. Clean the pessary with mild soap and warm water as well.
Apply lubricant: a water-based lubricant on the rim of the pessary reduces friction and makes insertion more comfortable.
Fold the ring: squeeze the ring pessary in half so it resembles a narrow oval or figure-eight shape. This is similar to how you’d fold a diaphragm or menstrual disc.
Find your position: stand with one foot elevated on a stool or toilet seat, or lie on your back with knees bent. Some people prefer squatting. The goal is to relax the pelvic floor muscles.
Insert gently: with the folded pessary angled slightly downward toward the tailbone, slide it into the vagina. Push it back as far as it comfortably goes. Once released, the ring will open and settle behind the pubic bone.
Check placement: you should be able to feel the rim of the pessary with a fingertip if you reach inside, but it should not protrude from the vaginal opening. Stand up, walk around, cough, and bear down. If it slips out or causes pressure, it may be the wrong size.

Removal is essentially the reverse: hook a finger under the rim, tilt the pessary slightly to break the seal against the vaginal walls, fold it, and slide it out. Some providers recommend removing the pessary nightly; others say weekly removal and cleaning is fine. Follow whatever schedule your provider recommends for your situation.

Gellhorn and Space-Occupying Pessaries Are Harder to Self-Manage

If you’ve been fitted with a Gellhorn, cube, or donut pessary, self-insertion tends to be trickier. These devices are bulkier and don’t fold as neatly. The Gellhorn, for example, has a flat disc and a stem, and inserting it requires compressing the disc, angling the stem correctly, and positioning the disc so it sits firmly against the cervix. Research bears out the difficulty: in the stage IV prolapse study mentioned above, about 84% of women with ring pessaries could manage their own care, compared with only 58% of those fitted with Gellhorn pessaries.³

Cube pessaries rely on suction against the vaginal walls to stay in place, which means they must be removed daily to prevent tissue damage. They can’t simply be shifted or rotated like a ring. However, a study of long-term cube pessary self-management found that over 90% of sexually active users reported that removing the cube before intercourse was not disruptive to their routine, suggesting that with practice, even these more complex shapes become manageable.⁴

If you’ve been given a space-occupying pessary and can’t comfortably manage it at home, that doesn’t mean you’ve failed. It means you’ll need periodic office visits for removal, cleaning, and reinsertion, which is a perfectly standard arrangement. Many women use pessaries for years under this model.

What Makes Insertion Easier Over Time

Most people find the first few attempts at self-insertion awkward. The angle feels unfamiliar, you may struggle to fold the device with lubricated fingers, and anxiety about doing it wrong can make pelvic muscles tighten involuntarily. A few practical tips that clinicians commonly share:

Relax and breathe: bearing down gently as if having a bowel movement can open the vaginal canal slightly and make insertion smoother.
Use plenty of lubricant: there is no penalty for using more than you think you need, and water-based lubricant won’t damage silicone pessaries.
Try different positions: if standing with one leg up isn’t working, switch to lying down, or vice versa. Body mechanics change with prolapse severity and even time of day.
Practice removal first: some providers suggest getting comfortable with removal before worrying about reinsertion, since removal tends to feel less intimidating and builds confidence with handling the device.

Modern pessaries are made from medical-grade silicone, which is flexible, non-reactive, and durable. Earlier materials like rubber, cork, and even brass were used historically, but silicone has been the standard for decades now.⁵ The silicone surface is smooth enough that with adequate lubrication, insertion should not cause pain. If it does, something needs to change, whether that’s the size, the type, or the amount of lubricant.

Vaginal Estrogen and Its Role in Comfort

If you’re postmenopausal, your provider may prescribe a topical vaginal estrogen cream or tablet alongside the pessary. The reasoning is straightforward: lower estrogen levels after menopause cause the vaginal tissue to become thinner, drier, and more fragile, which can make pessary use uncomfortable and theoretically increase the risk of tissue erosion. In practice, the evidence on whether vaginal estrogen actually prevents erosion is mixed. One study found erosion rates of about 37% among women using vaginal estrogen and 28% among those who did not, with no statistically meaningful difference.⁶ A randomized trial similarly found no significant difference in erosion between groups at six months.⁷

That said, vaginal estrogen does help with general comfort and lubrication, and many women report that the pessary feels less irritating when they use it. Researchers have even explored pessaries that slowly release estrogen directly, which could eliminate the need to apply cream separately.⁸ For now, though, the standard approach is a separate cream or tablet applied a few times a week. Whether or not vaginal estrogen prevents erosion in a statistically rigorous sense, many clinicians still recommend it for subjective comfort, which matters for long-term use.

Complications to Watch For

The most frequently reported problems with pessary use are vaginal discharge, erosion of the vaginal wall, and bleeding.⁹ Most of these are mild and manageable. A modest increase in discharge is normal and doesn’t necessarily mean something is wrong. Erosion, where the pessary rubs against the vaginal wall and causes a raw or ulcerated spot, is more concerning but typically heals once the pessary is removed for a period.

Certain signs should prompt you to see your provider sooner rather than later:

Foul-smelling discharge: this can indicate an infection or a retained and forgotten pessary, which is a real clinical problem when office-managed pessaries go too long between visits.
Bleeding: small amounts of spotting during initial use may be normal, but persistent or heavier bleeding warrants evaluation.
Pain or pressure: a well-fitted pessary should be essentially unnoticeable during daily activity. Persistent discomfort suggests a sizing issue or displacement.
Inability to urinate or have a bowel movement: a pessary that’s too large or poorly positioned can press on the urethra or rectum.

Serious complications like fistula formation or organ perforation are exceedingly rare and generally associated with neglected pessaries that haven’t been removed in months or years, not with routine self-managed use. Regular removal and cleaning, whether you do it yourself or visit a provider, is what prevents the rare severe outcomes.

Sex and Pessary Use

One of the most common questions people don’t ask their provider but do search online is whether you can have sex with a pessary in place. The answer depends on the type. Ring pessaries can technically stay in during intercourse, and some couples don’t notice them. But in one study of sexually active women using pessaries, about 70% removed the device before sex most or all of the time. The most common reasons were that a partner could feel it during intercourse and that the pessary was uncomfortable during sex.¹⁰ Overall sexual function scores didn’t change after starting pessary use, which is encouraging, though partner-related scores dipped slightly.

For space-occupying types like the Gellhorn or cube, removal before sex is essentially required because the device physically occupies the vaginal canal. The good news from the cube pessary study is that nearly three-quarters of sexually active users described their sexual wellbeing as better or much better after starting pessary treatment, likely because the prolapse symptoms themselves were the bigger barrier to intimacy than the device.⁴ If sexual function is a priority for you, mentioning this during your fitting visit can help your provider choose a type that’s easier to remove and reinsert around sexual activity.

How Long People Actually Stick With Pessaries

Learning to insert a pessary is a skill investment, so it’s reasonable to wonder whether you’ll still be using the device a year or five years from now. The data on this varies. A review of multiple studies found short-term continuation rates (three to four months) of roughly 50% to 80%, with those numbers staying fairly stable at the one-year mark.¹¹ Longer-term data is more sobering. One study tracking ring pessary users found cumulative continuation rates of about 84% at one year but only about 33% at ten years, with the most common reason for stopping being frequent expulsion, followed by vaginal erosion.¹² Another study of self-care pessary users reported a five-year continuation rate of about 54%, with the biggest drop-off happening in the first year; the top reason for discontinuing was wanting surgery instead, followed by discomfort.¹³

These numbers tell a useful story: if you make it through the first year, you’re more likely to continue long-term. The initial adjustment period is the hardest part, which makes sense given the learning curve around insertion, removal, cleaning, and getting used to the sensation. Being over 65 and being sexually active were both independently associated with longer-term pessary use in the research literature, though the reasons aren’t fully clear.¹¹ One reasonable interpretation: people who’ve decided against surgery and people who benefit from symptom relief during intimacy have the strongest motivation to persist through the learning curve.

Cervical Pessaries in Pregnancy Are a Different Device Entirely

If your search for pessary insertion brought up results about pregnancy, you’ve stumbled into a different conversation. The Arabin cervical pessary is a silicone ring placed around the cervix during pregnancy, intended to reduce the risk of preterm birth in women with a short cervix. It looks and functions differently from a prolapse pessary, and critically, a pregnant woman does not insert or remove it herself, it’s placed and managed entirely by an obstetrician.

The evidence for cervical pessaries in pregnancy prevention has been disappointing. A large randomized trial of women with singleton pregnancies and short cervixes found that the pessary did not reduce preterm birth before 37 weeks compared to usual care and was associated with a higher rate of fetal or infant death.¹⁴ In twin pregnancies with a short cervix, a separate trial and updated meta-analysis also found no significant reduction in preterm birth before 34 weeks.¹⁵ These findings have cooled enthusiasm for cervical pessaries in obstetrics, though research continues in specific subgroups. The takeaway if you’re pregnant and reading this: the cervical pessary is not something you’d be inserting yourself, and its clinical role is currently uncertain.

Why a Video Alone Isn’t Enough

Instructional videos from reputable medical centers can be a helpful refresher after you’ve already been taught in person. Seeing someone demonstrate the fold, the angle, and the checking technique on camera can reinforce what you learned at your fitting appointment, especially if a few weeks have gone by and the details are fuzzy. But a video can’t tell you whether your pessary is the right size, whether your anatomy has changed since your last visit, or whether the mild discomfort you’re feeling is normal friction or the beginning of an erosion. Those judgment calls require a provider, at least periodically.

If you’re struggling with insertion at home and watching videos hasn’t resolved the issue, the answer is almost always a return visit, not more internet research. Your provider can observe your technique, suggest a different body position, try a different pessary size, or switch to a type that’s easier for your particular anatomy. Satisfaction rates at the first follow-up visit after fitting are high: over 90% for both ring and Gellhorn users in one study.³ Most of the frustration with pessary use resolves within the first few weeks once you and your provider have landed on the right fit and the right routine.

1
DeckerMed Obstetrics and Gynecology. Pessary Management for the General Gynecologist
2
SpringerOpen. Ring and Gellhorn pessaries used in patients with pelvic organ prolapse: a retrospective study of 8 years
3
PubMed Central. Outcomes of pessary fitting trials for patients with stage IV pelvic organ prolapse: a prospective study
4
PubMed Central. Long-Term Self-Management of Vaginal Cube Pessaries Can Improve Sexual Life in Patients with Pelvic Organ Prolapse, Results from a Secondary Analysis
5
PubMed. The history and evolution of pessaries for pelvic organ prolapse
6
PubMed Central. Effect of vaginal estrogen on pessary use
7
PubMed. ESTROgen use for complications in women treating pelvic organ prolapse with vaginal PESSaries (ESTRO-PESS)-a randomized clinical trial
8
Scientific Reports. An estriol-eluting pessary to treat pelvic organ prolapse
9
PubMed Central. An integrative review and severity classification of complications related to pessary use in the treatment of female pelvic organ prolapse
10
PubMed Central. Sexual Function and Pessary Management Among Women Using a Pessary for Pelvic Floor Disorders
11
PubMed Central. Pessary treatment for pelvic organ prolapse and health-related quality of life: a review
12
PubMed. Long-term continuations rate of ring pessary use for symptomatic pelvic organ prolapse
13
PubMed. Long-Term Compliance of Self-Care Pessary in Symptomatic Pelvic Organ Prolapse
14
JAMA. Cervical Pessary for Prevention of Preterm Birth in Individuals With a Short Cervix: The TOPS Randomized Clinical Trial
15
PubMed Central. Evaluation of the Arabin cervical pessary for prevention of preterm birth in women with a twin pregnancy and short cervix (STOPPIT-2): An open-label randomised trial and updated meta-analysis