A ring pessary is a common non-surgical medical device, typically made of silicone, used to provide mechanical support within the vagina. This device is frequently employed to manage symptoms related to pelvic organ prolapse or to assist in controlling stress urinary incontinence. This article provides guidance on the process of self-insertion. Individuals attempting this process must have already received instruction, fitting, and sizing from a qualified healthcare professional. Attempting self-insertion without prior clinical guidance can lead to discomfort or improper device function.
Preparing for Self-Insertion
Before beginning insertion, gather the necessary supplies: the ring pessary, a mild, non-irritating lubricant, and mild soap and warm water for hand hygiene. Using a generous amount of water-based lubricant is highly recommended, as it significantly reduces friction. This preparation step helps the device glide easily through the vaginal opening and makes the insertion process more comfortable.
Proper hand hygiene is mandatory to prevent the introduction of bacteria into the vaginal canal. Hands should be thoroughly washed with mild soap and warm water for at least 20 seconds immediately before handling the device. Choose a body position that allows the pelvic muscles to relax, facilitating easier placement. Many people find success by squatting, standing with one foot elevated, or lying down with knees bent and hips slightly elevated.
Step-by-Step Insertion Technique
Once preparation is complete, the process of inserting the ring pessary can begin. A standard ring pessary needs to be folded to decrease its overall diameter, making it easier to pass through the vaginal opening. The most common technique is to fold the flexible ring in half, creating a narrow, U-shaped or “taco” configuration.
Hold the folded pessary with the open side facing away from the body. Use the non-dominant hand to gently spread the labia to expose the vaginal entrance. The lubricated, folded edge is then carefully guided into the opening. The angle of insertion is important; the device should be directed slightly downward and backward, following the natural curve of the vaginal canal toward the tailbone.
The insertion should be a slow, steady motion, ensuring the pessary does not snap open prematurely. As the pessary is guided deeper, it must be pushed upward into the upper vaginal space. The goal is to maneuver the device past the pubic bone and into the posterior fornix, which is the deepest part of the vagina.
As the pessary clears the vaginal entrance and moves into the upper third of the canal, the pressure on the fold can be released. The ring will naturally spring back into its circular shape. Use a finger to gently push the pessary further up and back until it rests against the posterior vaginal wall. The front edge of the ring should be tucked behind the pubic bone, creating a secure, supportive shelf.
The final placement should feel secure and stable, providing the necessary support without causing immediate sharp pain or significant discomfort. The entire device must be fully inside the body, with no part protruding. Proper technique ensures the pessary remains in place during normal daily activities, effectively managing the symptoms it is intended to address.
Removal, Cleaning, and Maintenance
Managing the ring pessary includes a regular routine of removal and cleaning. The frequency of removal is typically determined by the prescribing healthcare provider, often ranging from daily to once or twice a week, depending on the individual’s specific condition. Before attempting removal, thoroughly clean your hands and assume a comfortable, relaxed position, such as squatting or standing with one foot raised.
To remove the device, insert a finger into the vagina until it hooks under the lower edge of the ring. This can be the most challenging part, requiring patience and relaxation of the pelvic floor muscles. Once secured, apply gentle, steady traction, pulling the ring downward and outward, following the same slight downward angle used during insertion. If the ring is difficult to grasp, try bearing down gently, which helps push the pessary slightly lower within the canal.
Immediately after removal, clean the pessary using mild, unscented soap and lukewarm water. Harsh chemicals, perfumes, or abrasive cleaners should be avoided, as these can degrade the silicone material or cause irritation upon reinsertion. Rinse the device completely under running water to ensure all soap residue is removed before it is dried and reinserted or stored.
If the healthcare provider recommends that the pessary only be removed for cleaning every few weeks or months, proper maintenance still involves checking the device regularly to ensure it is clean and properly positioned. If the ring is removed for an extended period, such as during menstruation, store it in a clean, dry container away from direct sunlight. Consistent cleaning and maintenance help prevent odor, irritation, and the risk of infection.
Checking Placement and Troubleshooting
After successful insertion, confirming the proper position of the ring pessary is necessary to ensure comfort and efficacy. A correctly placed pessary should not be noticeable during normal activities such as walking, sitting, or standing. The user can gently insert a clean finger to confirm the ring is positioned high up in the vagina and is sitting securely behind the pubic bone.
Signs of improper placement include feeling the device protruding from the vaginal opening or experiencing sharp, localized pain. If the pessary falls out entirely, it indicates either incorrect insertion technique or that the device sizing may need to be re-evaluated by a clinician. Discomfort should prompt immediate removal and reinsertion, ensuring adequate lubrication and correct angling.
Persistent pain, difficulty removing the device, or any signs of vaginal irritation or infection require prompt contact with a healthcare provider. Symptoms like unusual discharge, foul odor, or unexplained bleeding signal that vaginal tissues may be compromised and need professional assessment. Continuing to wear a device that causes prolonged discomfort can lead to ulceration or other complications.