A pessary is a removable, medical-grade silicone device placed inside the vagina to provide physical support for pelvic organs, most commonly used to manage symptoms of pelvic organ prolapse or stress urinary incontinence. The ring pessary with a knob is a popular design because the knob provides additional support behind the pubic bone to help prevent urinary leakage. It also serves as a handle for easier self-management, including removal. This guide provides detailed instructions for self-insertion, but you must always follow the specific instructions and fitting advice provided by your own healthcare provider.
Essential Preparation Before Insertion
Before attempting to insert the device, proper hygiene is necessary to avoid introducing bacteria into the vaginal canal. Begin by thoroughly washing your hands with soap and warm water. Then, clean the silicone pessary itself with a mild soap and water, ensuring it is well-rinsed and dried. This cleaning process is especially important if the pessary has been stored outside its original packaging.
Gathering your supplies, including a generous amount of water-based lubricant, should be done before you begin the physical insertion process. Lubrication is important to reduce friction and minimize discomfort during the insertion of the folded pessary. You should also select a comfortable position that allows for easy access to the vaginal opening, such as standing with one foot propped on a chair, squatting down, or lying on your back with your knees bent.
Step-by-Step Guide to Insertion
Insertion of the ring pessary with a knob begins by folding the device to reduce its diameter, which makes passing it through the vaginal opening easier. Grasp the ring on opposite sides, usually where small notches are present, and fold it in half to create a flattened “U” or “taco” shape. The knob should be positioned toward one of the sides, not directly on the fold, to allow for the tightest possible compression.
Apply a small amount of water-based lubricant to the leading edge of the folded pessary, which is the end without the knob. Use your non-dominant hand to gently spread the labia to locate the vaginal opening, and then hold the compressed pessary firmly in your dominant hand. The folded, lubricated end should be inserted first, aiming the device downward and backward toward your tailbone, following the natural curve of the vaginal canal.
Continue to gently push the pessary into the vagina as far as your finger can comfortably reach, maintaining the compressed shape until it is fully inside the canal. Once the pessary is past the muscular opening, you can release your grip. The flexible silicone device will spring back to its original circular shape inside the wider upper part of the vagina. The final step involves positioning the device correctly using the knob as a guide.
Use your index finger to find the knob and rotate the pessary so that the knob is positioned in the front, sitting just behind the pubic bone and resting directly beneath the urethra. This specific placement provides the required support to the bladder neck, which is designed to reduce stress urinary incontinence. The main ring of the device should be settled high up in the vagina, specifically in the posterior fornix, to provide maximum support for the pelvic organs.
Checking Placement and Troubleshooting Common Issues
After insertion, it is necessary to check the placement to confirm the pessary is correctly seated and comfortable. The main indicator of proper placement is that you should not be able to feel the device when moving, walking, or sitting. If you feel a constant pressure, or if the pessary feels like it is about to slip out, it is likely not positioned high enough or is sitting incorrectly within the vaginal vault.
To confirm the knob’s position, you can gently feel the front wall of the vagina just inside the opening. The knob should be accessible, but it should not be irritating the delicate tissues around the vaginal entrance. If the pessary feels uncomfortable, try removing it, applying more lubricant, and reinserting it while experimenting with a slightly different body position during the insertion process.
A common issue is the pessary slipping out, which can happen when coughing, straining, or during a bowel movement. This slippage usually indicates that the initial fitting was not the correct size, or that the device was not pushed far enough back and up toward the posterior fornix. If you repeatedly have difficulty keeping the device in place or experience persistent discomfort, you should contact your healthcare provider to check the pessary’s size or recommend a different style.