A ring pessary is a soft, removable silicone device placed inside the vagina to provide support to the pelvic organs. It is most commonly used to manage symptoms of pelvic organ prolapse, such as descended organs like the bladder or uterus, and to help with stress urinary incontinence. The ring shape is frequently recommended for mild to moderate prolapse and is designed for self-management by the user. Once a healthcare provider has determined the correct size and type, self-insertion and removal become part of routine care.
Preparing for Insertion
Proper preparation is necessary for a successful and hygienic insertion. Begin by thoroughly washing your hands with soap and water to prevent the introduction of bacteria. Next, clean the ring pessary with mild soap and water, rinsing it completely and drying it before use. Applying a water-based lubricant, such as a jelly or local estrogen cream, to the insertion edge of the pessary will significantly ease the process.
Finding a comfortable body position is necessary before starting the insertion. Many women find it easiest to stand with one foot propped on a chair, lie down with knees bent, or assume a slight squatting position. Relaxing the pelvic floor muscles in your chosen position will make the insertion much smoother. Remember that the pessary must be sized and approved by your physician, as an improperly fitted device can cause discomfort or fail to provide support.
Step-by-Step Insertion Technique
The initial step involves folding the flexible silicone ring to reduce its diameter for easier passage. A common method is to fold the ring in half, creating a narrow, elongated shape, sometimes described as a “taco” or “figure-eight.” Hold the folded pessary securely with your dominant hand, ensuring the leading edge is lubricated. Use your non-dominant hand to gently separate the labia at the vaginal opening.
Carefully introduce the folded pessary into the vagina, angling it backward and slightly downward toward the tailbone, following the natural curve of the canal. Slide the device inward until you feel resistance or until the folded shape is fully inside. Once past the opening, release the fold, allowing the ring to spring open to its full, supportive shape. It will naturally assume a horizontal or slightly angled position inside the body.
The final action is to gently push the pessary further up and toward the back of the vagina, into the vaginal vault. This tucks the front rim of the ring securely behind the pubic bone. If a cervix is present, a correctly positioned ring should sit with the cervix centered within the opening. This deep placement ensures the ring is anchored and provides structural support.
Verifying Proper Placement
Immediately after insertion, the most important indicator of correct placement is comfort. A properly situated ring pessary should be imperceptible; you should not feel pressure, rubbing, or pain inside the vagina. If you experience discomfort or a feeling of fullness, the pessary may not be fully in place. You can check the position by inserting a clean index finger into the vagina.
Sweep your finger around the rim to ensure it is tucked high and behind the pubic bone, with the back resting behind the cervix. The ring should not be protruding from the vaginal opening. To confirm a snug fit, a finger should pass easily around its circumference. To test stability, move, cough, or bear down gently. If the ring remains stable and does not shift, the placement is likely correct.
Instructions for Removal and Cleaning
Removing the ring pessary also begins with hand hygiene and finding a comfortable position, such as standing with one foot raised. Insert your index finger into the vagina until you locate the rim of the ring, typically felt just under the pubic bone. Hook your finger under the rim or through the center of the ring, if applicable.
Gently pull the ring downward and slightly out, angling it to follow the path of the vagina. You may need to slightly fold or tilt the ring to ease its passage through the vaginal opening. Once removed, clean the pessary immediately using mild soap and warm water, scrubbing the surface gently. Rinse the device thoroughly to remove all soap residue, as remaining soap can cause irritation upon reinsertion.
After cleaning, allow the pessary to air dry completely before storage or reinsertion. The recommended frequency for removal and cleaning varies, with some women removing it nightly or weekly, while others may leave it in for longer periods as advised by their doctor. Following your physician’s specific instructions for maintenance is important for maintaining vaginal health and preventing complications.