A pessary is a soft, flexible medical device inserted into the vagina, primarily used to provide mechanical support for the pelvic organs, managing conditions like pelvic organ prolapse or stress urinary incontinence. This treatment holds the bladder, uterus, or rectum in a more natural position, alleviating symptoms like pressure or leakage. Routine removal is important for hygiene, cleaning, and inspection to maintain vaginal health and prevent complications. Self-removal and reinsertion give users greater control over their care.
Essential Preparation for Removal
Before removal, thorough handwashing with soap and water is necessary to minimize the risk of introducing bacteria into the vagina. Finding a private and comfortable position is important for a relaxed state, which eases the process. Common positions include standing with one foot elevated, squatting, or lying down with knees bent.
Relaxing the pelvic floor muscles is essential for successful removal, as tension can tighten the vaginal canal around the device. Applying water-based lubricant or a prescribed vaginal cream to the vaginal opening and inside the canal reduces friction. This helps the pessary slide out smoothly and prevents irritation to the vaginal tissues during extraction.
Detailed Steps for Safe Self-Removal
Begin by inserting a clean finger to locate the pessary, feeling for the rim or projection. For a ring-style pessary, hook a finger, usually the index finger, under the rim or through the central opening. Once a secure hold is established, gently pull the device downwards and outwards, aiming toward the back of the vagina.
If using a cube or Gellhorn pessary, which relies on suction, the first step is to break the seal. Sweep a finger around the edge of the device to introduce air between the silicone and the vaginal wall. For a cube pessary, do not pull on the retrieval string; instead, use a finger to collapse the device or gently roll it downward.
For a ring pessary, gently folding or collapsing the device into a figure-eight or ‘V’ shape reduces the diameter for easier passage through the vaginal opening. Use slow, steady pressure rather than sudden force. Bearing down slightly, similar to a gentle push during a bowel movement, can help lower the device into a more reachable position. If the device resists removal, stop, change position, and try again, ensuring you are pulling toward the vaginal opening.
Cleaning and Care of the Device
Rinse the pessary under warm running water immediately after removal to remove discharge or secretions. Clean the entire surface using a mild, unscented soap. Pay special attention to crevices, holes, or textured areas where debris might accumulate, especially on cube or folding pessaries.
The device must be thoroughly rinsed for at least 30 seconds to ensure no soap residue remains, as this can cause vaginal irritation upon reinsertion. Dry the pessary completely with a clean, lint-free towel or allow it to air dry on a sanitized surface. Before reinserting, visually inspect the silicone material for signs of wear, such as cracks, tears, or sharp edges, which indicate the device needs replacement. Store the device in a clean, dry place, away from direct heat or sunlight, if it is not being reinserted immediately.
Warning Signs and Professional Assistance
If you cannot reach or grasp the device after several attempts, or if the pessary feels deeply lodged, stop and contact a healthcare professional. Persistent or worsening pain during removal is a signal to discontinue the process and seek medical evaluation. Trying to force the device out can damage vaginal tissues.
Seek immediate professional advice if you notice signs that can indicate an infection or vaginal erosion:
- Abnormal vaginal discharge, such as a change to a yellow or green color or a foul odor.
- An increase in bloody discharge.
- The device appears to be embedded in the vaginal wall.
- Fever, chills, or difficulty urinating.
A healthcare provider can safely remove the device, assess vaginal health, and determine if an adjustment in pessary type or size is necessary.