A pessary is a soft, removable device, typically made of silicone, that is placed inside the vagina to provide support to the pelvic organs. This non-surgical treatment manages symptoms of pelvic organ prolapse, where organs like the bladder or uterus have shifted, or treats stress urinary incontinence. The device offers internal structural support to keep organs in correct alignment, alleviating feelings of pelvic pressure or fullness. The size and specific type of pessary, such as a ring or cube, are determined by a healthcare provider to ensure a proper and effective fit for your unique anatomy and condition.
Preparing for Insertion
Before handling the pessary, establish a clean and comfortable environment to minimize the risk of introducing bacteria. Begin by washing your hands thoroughly with soap and warm water, scrubbing for at least twenty seconds, as this hand hygiene is the first line of defense against infection.
Finding a comfortable body position that allows easy access to the vaginal opening is also helpful for a smooth insertion process. Some people prefer standing with one foot elevated on a stable surface, while others find lying on their back with knees bent or a deep squatting position works best.
To ease the passage of the device and reduce friction, apply a small amount of water-based lubricant to the leading edge of the pessary. Using a water-based product is necessary because petroleum-based lubricants can damage the silicone material over time.
Step-by-Step Insertion Techniques
The physical technique for insertion depends on the shape of the prescribed device, with ring and cube pessaries being the most common types managed at home. Relaxation is an important aspect of insertion, as tensing the pelvic floor muscles can make the opening smaller and the process more difficult. A properly placed pessary should be completely unnoticeable when you are standing, walking, or engaging in daily activities. If you feel pressure, discomfort, or the edge of the pessary, it may not be positioned correctly and should be removed and reinserted.
Ring Pessary Insertion
For a flexible ring pessary, the device must be folded in half, often called the “taco fold,” to reduce its diameter for easier entry into the vaginal canal. Hold the folded ring with the curved part facing upward, and use your non-dominant hand to gently separate the labia at the vaginal opening.
Insert the folded pessary into the vagina, aiming the device downward and backward toward the lower back, similar to inserting a tampon. Continue to push the pessary gently but firmly until it is fully past the pubic bone and into the upper part of the vagina. As you release the ring, it will spring open and settle into its correct supportive position behind the pubic bone.
Cube Pessary Insertion
The cube pessary is a space-filling device that uses suction for stability. The insertion method involves compressing the cube as much as possible with your fingers.
The cube is then guided into the vagina at an angle, corner-first, with the goal of pushing it past the opening and into the upper vaginal space. Push the cube as high as it will comfortably go, which allows the device to expand and create the necessary suction against the vaginal walls.
Removal, Cleaning, and Storage
The maintenance cycle for a pessary begins with its removal, which should follow the frequency determined by your healthcare provider, ranging from daily or weekly to monthly.
Pessary Removal
To remove a ring pessary, insert a clean finger into the vagina until you can locate the rim of the device. Hook your finger under the rim, gently tilting the pessary to break any natural suction and reduce its overall circumference as you pull it downward and out of the vagina.
For a cube pessary, the removal process focuses on breaking the suction created by the concave sides before extraction. Locate the small loop or string attached to the cube, but do not pull on it, as this can damage the vaginal tissue. Instead, slide a finger along the vaginal wall until you reach the side of the cube, then gently hook your fingertip over the edge to break the vacuum seal. Carefully “unroll” the cube by breaking the suction on each side sequentially as you guide the compressed device out of the vaginal opening.
Cleaning and Storage
Once removed, the device must be cleaned immediately to prevent the build-up of secretions and odor. Cleaning involves washing the pessary with warm water and a mild, unscented soap, gently rubbing the surface to dislodge any residue.
Thoroughly rinse the device under running water to ensure no soap residue remains, as this could cause vaginal irritation upon reinsertion. After cleaning, the pessary should be dried completely with a clean, non-shedding towel or allowed to air dry. If you are not reinserting the pessary right away, store it in a clean, dry container away from direct sunlight until its next use.
Managing Use and Troubleshooting Common Issues
A correctly sized and positioned device should not cause any pain, and you should be able to urinate and have a bowel movement without difficulty. It is normal to observe a slight increase in vaginal discharge, which is the body’s natural response to a foreign object. This discharge should be white or clear with no strong odor.
You can confirm the pessary is still correctly positioned by checking that you do not feel its edge or the return of your original prolapse symptoms when you cough, lift, or exercise. If you experience persistent discomfort, develop a foul-smelling or discolored discharge, or notice any vaginal bleeding, this may signal irritation or a possible infection and requires prompt consultation with your healthcare provider.
Difficulty removing the device or having it repeatedly fall out are issues that need professional attention, as they usually indicate a need for a different size or type of pessary. If the pessary falls out, clean it thoroughly according to the prescribed instructions before attempting reinsertion. Never force the device during insertion or removal, and always contact your clinician if you are unable to manage the pessary or experience persistent pain.