Removing a vaginal pessary is a skill that most people can learn with a little guidance and practice. If your healthcare provider has recommended self-management, you are joining a growing group of women who handle their own pessary care at home. The process is straightforward once you understand the basic technique, though the exact steps vary depending on which type of pessary you use. What follows is a practical walkthrough of preparation, removal, cleaning, and reinsertion, along with answers to the questions that come up most often once you start managing a pessary on your own.
Getting Ready
Before you touch the pessary, set yourself up for a comfortable experience. Wash your hands thoroughly with soap and warm water. Gather a mild, unscented soap (or the cleanser your provider recommended), a clean towel, and optionally a water-based lubricant for reinsertion later. Some people find it helpful to have a hand mirror nearby, especially during the first few attempts.
Choose a position that gives you easy access. The three most common options are standing with one foot up on a stool or the edge of a bathtub, squatting, or lying on your back with your knees bent and apart. Try different positions in the beginning to see which one feels most natural. Many people settle on the standing-with-one-foot-up approach because it opens the vaginal canal while keeping you balanced.
Relaxation matters more than you might expect. Tensing the pelvic floor muscles makes the vaginal walls grip the pessary more tightly. Take a few slow breaths and consciously relax your abdomen and pelvic area before reaching in. If you have been taught pelvic floor exercises, think about doing the opposite of a squeeze: a gentle bearing-down or bulging motion can help push the pessary lower and closer to the opening.
Removing a Ring Pessary
Ring pessaries are the most commonly prescribed type, and they are also the easiest to remove yourself. The ring is a flexible silicone circle, sometimes with a small notch or fold-down area built into the rim. Here is the step-by-step process:
- Locate the rim: Insert one or two fingers into the vagina and feel for the edge of the ring. It usually sits behind the pubic bone, so you may need to reach slightly upward and toward the front.
- Hook the rim: Slide your index finger (or index and middle fingers together) under the lower edge of the ring. If the pessary has a notch, hooking your finger into the notch gives you a secure grip.
- Tilt and fold: Gently pull the near edge of the ring downward and toward you while tilting it at an angle. The ring does not need to come out flat. Folding it slightly reduces its diameter, making it pass through the vaginal opening more comfortably.
- Slide it out: With steady, gentle traction, guide the folded ring out. Move slowly. If it feels like it catches or stalls, pause, take a breath, bear down slightly, and then continue pulling.
The whole process typically takes under a minute once you have done it a few times. During your first couple of attempts it can feel awkward, and that is completely normal. Your provider may have demonstrated the technique during an office visit and given you a chance to practice there before sending you home. If you were not offered that opportunity and feel uncertain, ask for one at your next appointment.
Removing Other Pessary Types
Not everyone uses a ring. Other common shapes include the Gellhorn, the donut, and the cube. Each has a slightly different removal technique.
A Gellhorn pessary looks like a disc with a stem. To remove it, reach in and find the stem (it points toward the vaginal opening). Grasp the stem between two fingers, gently rotate the disc so it tilts sideways, and pull it out at an angle. The disc portion is rigid compared to a ring, so tilting is essential to avoid discomfort.
A donut pessary is a thick, soft torus. It does not fold as easily as a ring, but you can compress it somewhat. Hook a finger into the center hole, angle it, and guide it out with steady pressure. Because of its bulk, you may need to bear down more actively while pulling.
A cube pessary works differently from the others. Cubes rely on gentle suction against the vaginal walls to stay in place, so you need to break that suction before pulling. Reach in, find an edge or corner, and press a finger between the cube and the vaginal wall. Once you feel the seal release, you can grip the cube and slide it out. Some cube pessaries have a string or loop specifically for removal; if yours does, pull on it gently while bearing down. Never yank sharply on any pessary.
What to Do If It Feels Stuck
Feeling like you cannot get a grip on the pessary, or like it will not budge, is a common experience in the early days of self-management. Almost always, the issue is muscle tension or positioning rather than a genuine mechanical problem. Here are some troubleshooting steps:
- Change position: If you have been standing, try squatting or lying down. Gravity and the angle of your pelvis shift with each position, and sometimes that is all you need.
- Bear down gently: The same pushing motion you would use during a bowel movement moves the pessary lower in the vaginal canal, bringing it within easier reach.
- Add lubricant: A small amount of water-based lubricant on your fingers can help them glide past the vaginal walls to reach the pessary edge.
- Wait and try again: If frustration builds, stop and try again in an hour or the next day. A pessary sitting in place for an extra day is not dangerous.
If you have tried multiple times over a day or two and still cannot remove it, call your provider’s office. They can remove it quickly and help you figure out what adjustment to your technique might help next time. In one prospective study, about half of women with ring pessaries experienced some kind of adverse event that led to a temporary removal by their clinician during a follow-up period, so clinic visits for help are a routine part of pessary care, not a sign of failure.
Cleaning and Reinsertion
Once the pessary is out, wash it with warm water and a mild, unscented soap. Avoid harsh chemicals, alcohol-based cleansers, or boiling, since these can degrade the silicone over time. Rinse it thoroughly, pat it dry with a clean towel, and inspect it for cracks, rough spots, or discoloration. A pessary in good condition has a smooth, uniform surface. If you notice any damage, contact your provider before reinserting it.
To reinsert, apply a thin layer of water-based lubricant to the pessary’s leading edge and to the vaginal opening. For a ring, fold it in half (like folding a taco), slide it into the vagina angled slightly downward toward the back, and then release it so it opens and settles behind the pubic bone. For a Gellhorn, angle the disc so it enters sideways and then rotates into position with the stem pointing toward the opening. Cubes can be compressed and guided in, and they re-establish suction on their own once released.
After reinsertion, stand up and walk around. Cough a few times or bear down briefly. The pessary should not feel like it is slipping out. If it does, it may not be seated deeply enough; try removing and reinserting it a bit further back. If it consistently slips despite correct placement, your provider may need to refit you with a different size.
How Often Should You Remove It
Provider recommendations on removal frequency vary. Traditional clinic-based care often involves having a professional remove and clean the pessary every three to six months, but many clinicians now teach patients to remove theirs more frequently at home. Common self-management schedules include nightly removal (taking it out before bed and reinserting it in the morning) or removal once or twice a week for cleaning. Your provider will suggest a schedule based on your particular pessary type, your comfort level, and your vaginal health.
A prospective study of women with ring pessaries found that about 92% maintained successful pessary use over the study period, but roughly half experienced adverse events that required temporary removal. The most frequent issue was increased vaginal discharge, occurring in about three-quarters of those who had a problem. In a small number of cases, the ring became embedded in the vaginal tissue when left in place for extended periods.1PubMed Central. How often should ring pessaries be removed or changed in women with advanced POP? A prospective observational study Regular removal and cleaning reduce the likelihood of these issues.
Common Complications and How to Spot Them
The most frequently reported problems with pessary use are vaginal discharge, tissue erosion, and minor bleeding.2PubMed Central. An integrative review and severity classification of complications related to pessary use in the treatment of female pelvic organ prolapse None of these are unusual, and most resolve with simple adjustments. Increased discharge is the body’s response to having a foreign object in the vaginal canal. It can range from thin and watery to thicker and more noticeable. A change in color to green or yellow, or a foul smell, suggests infection and warrants a call to your provider.
Erosion means the pessary has rubbed away a small area of the vaginal lining. You might notice pink or blood-tinged discharge, or feel a sore spot. The risk of erosion rises with longer intervals between removals and with pessaries that have sharper edges or are slightly too large. Complications have been linked to the shape and material of the pessary as well as how long it stays in place.2PubMed Central. An integrative review and severity classification of complications related to pessary use in the treatment of female pelvic organ prolapse If you spot signs of erosion during a routine removal, leave the pessary out for a few days to let the tissue heal, and let your provider know.
Serious complications such as a pessary becoming deeply embedded, causing a fistula, or leading to bowel obstruction are rare and almost exclusively associated with neglected pessaries that go unremoved for months or years. Consistent self-care at home is one of the simplest ways to prevent severe problems.
Vaginal Estrogen and Pessary Comfort
Many people who use a pessary are postmenopausal, and lower estrogen levels thin the vaginal walls and reduce natural lubrication. This makes the tissue more vulnerable to irritation from the pessary. Providers often prescribe a topical vaginal estrogen cream, tablet, or ring to counteract this.
Research supports the benefit. In one study, women who used vaginal estrogen alongside their pessary were significantly less likely to develop increased vaginal discharge compared with those who did not: roughly 16% versus 32%. Women using estrogen were also less likely to discontinue pessary use altogether, with about 31% stopping compared with nearly 59% of non-users.3PubMed Central. Effect of vaginal estrogen on pessary use Interestingly, the same study found that vaginal estrogen did not reduce the rate of tissue erosion, so estrogen is not a cure-all but it does improve day-to-day comfort and makes long-term pessary use more sustainable.
If you are currently managing a pessary without vaginal estrogen and you are experiencing dryness, irritation, or persistent discharge, it is worth raising the topic with your provider. The doses used locally are very low and are generally considered safe even for people who cannot take systemic hormone therapy.
Why Self-Management Is Worth Learning
Traditionally, pessary care meant returning to the clinic every few months so a nurse or doctor could remove, clean, and reinsert the device. That model works, but it creates a dependency on appointment availability and travel, particularly burdensome for people with mobility issues or who live far from a specialist.
A quality-improvement project in the UK trained women to manage their own pessaries and followed them for six months. About 73% of the participants successfully continued with self-management. Those who self-managed reported higher levels of convenience (94% vs. 81%), accessibility (97% vs. 73%), and comfort (86% vs. 53%) compared with their experience attending the hospital or GP office for pessary changes.4PubMed Central. Self-management of vaginal pessaries for pelvic organ prolapse The program also freed up over 125 outpatient appointment slots in a single year, meaning self-management benefits clinics as well as patients.
The TOPSY intervention, developed specifically to support pessary self-management, includes a one-on-one session with a trained pessary practitioner, a follow-up phone call about two weeks later, and ongoing access to support by phone or in person whenever the woman feels she needs it.5PubMed Central. Theoretical and practical development of the TOPSY self-management intervention for women who use a vaginal pessary for pelvic organ prolapse If your clinic does not offer a structured self-management program, the basic elements are the same: hands-on demonstration, a chance to practice with guidance, and a contact number for questions once you are on your own.
When to Contact Your Provider
Self-management does not mean going it alone without a safety net. Reach out to your provider if you experience any of the following:
- Persistent pain: A well-fitting pessary should not hurt. Ongoing discomfort may mean the size or type needs to change.
- Foul-smelling discharge: This can signal a vaginal infection that needs treatment.
- Bleeding beyond light spotting: Especially if it happens repeatedly at removal or between removals.
- Difficulty with urination or bowel movements: A pessary that has shifted can press on the urethra or rectum.
- Inability to remove the pessary: After trying the troubleshooting steps above, a clinic visit is the right next step.
- Visible damage to the pessary: Cracks or rough patches can irritate tissue. Your provider can replace it.
Routine follow-up visits are still a good idea even for confident self-managers. Many providers recommend a check-in once or twice a year so they can examine the vaginal tissue, confirm the pessary still fits well, and adjust the care plan as needed.
A Long History of a Simple Device
Pessaries are among the oldest medical devices still in use. References to pessary-like supports appear in Egyptian papyruses and in the writings of Hippocrates. Over the centuries, clinicians experimented with everything from pomegranates and honey to linen soaked in wine and herbal preparations. By the time new materials became available, cork and brass versions gave way to rubber, and eventually to the non-reactive silicone used today.6PubMed. The history and evolution of pessaries for pelvic organ prolapse Modern pessaries come in a wide range of shapes and sizes, but the underlying concept has not changed much: provide mechanical support so the pelvic organs stay where they belong. The biggest shift in recent decades is not the device itself but the move toward empowering patients to handle their own care, turning what was once a clinic-dependent routine into something you can manage in your own bathroom.