A pessary is a medical device, typically made of soft, flexible silicone, that is inserted into the vagina to provide structural support for pelvic organs. It is commonly used to manage symptoms related to pelvic organ prolapse (where organs like the bladder or uterus descend into the vagina) or for stress urinary incontinence. Many types of pessaries, such as the ring, donut, or cube, are designed for patient self-management, allowing individuals to remove and reinsert the device at home. Self-removal offers greater control and can reduce the need for frequent clinic visits, but always follow the specific directions given by your healthcare provider.
Essential Preparation and Timing
The required frequency for pessary removal depends on the specific device type and your doctor’s recommendation, often ranging from daily to once every one to two weeks. Cube pessaries generally need daily removal, while ring pessaries can often be left in place for longer periods. Many individuals choose to remove the device before bed and reinsert it in the morning, which gives the vaginal tissue a break and allows for thorough cleaning.
Before attempting removal, wash your hands thoroughly with soap and water to minimize the risk of introducing bacteria. Gather a clean towel and mild, unscented soap for cleaning the device later. Finding a comfortable and stable position is important, such as standing with one foot elevated on a stool, squatting, or lying on your back with knees bent.
Step-by-Step Self-Removal Guide
Locate the device by inserting one or two fingers into the vagina until you feel its edge or rim. The pessary is often positioned high, behind the pubic bone, requiring you to reach a considerable distance. Bearing down gently, as if having a bowel movement, can help lower the device slightly and make it easier to reach.
For ring or donut pessaries, hook your index finger under the rim. To facilitate removal and minimize discomfort, fold the pessary as you pull it out. Gently pull the pessary downward and outward, using your other hand to compress it into a taco-like or V-shape as it approaches the vaginal opening. If folding is difficult, try turning the rim to a vertical, 45-degree angle to avoid withdrawing the widest part horizontally.
Cube and Gellhorn pessaries use suction to stay in place and require an extra step before physical removal. If using a cube pessary with a removal string, do not pull the string immediately. Instead, sweep a finger around the edges of the cube to break the vacuum seal. Once the suction is released, gently ease the device down the vagina by pulling on the rim or the string. The cube will naturally compress as it exits.
Maintenance and Troubleshooting After Removal
Immediately after removal, the pessary should be cleaned to maintain hygiene and prevent irritation or infection. Use mild, unscented soap and warm water, paying close attention to any grooves or textured areas where discharge may accumulate. Rinse the pessary under warm running water for at least 30 seconds to ensure all soap residue is removed, as residue can irritate sensitive vaginal tissues.
Allow the device to air dry before being reinserted or stored. If you are not reinserting it right away, store it in a clean, non-airtight container. Regularly inspect the device for signs of damage, such as rough edges, discoloration, or cracks, which indicate a need for replacement.
Contact your healthcare provider immediately if you are unable to remove the pessary after several attempts or if removal causes significant pain. Other symptoms requiring attention include unexplained vaginal bleeding or spotting, or unusual changes in discharge (such as increased amount or foul odor). These symptoms may signal an infection, tissue irritation, or that the pessary needs refitting.