A ring pessary is a non-surgical, removable device placed inside the vagina to provide mechanical support for pelvic organs. It is commonly used to manage symptoms of pelvic organ prolapse (POP) or stress urinary incontinence. Understanding the expected position and sensation of the device helps ensure its effectiveness and the user’s comfort, especially when performing self-checks for placement.
The Purpose and Position of a Ring Pessary
The ring pessary functions by sitting high in the vaginal vault, creating a supportive shelf that helps hold the descended pelvic organs in their correct anatomical location. When correctly fitted and positioned, the user should not be aware of its presence during routine daily activities. Activities like standing, walking, or using the restroom should occur without a noticeable feeling of pressure or discomfort.
If the ring is constantly felt or causes pressure on the vaginal walls, it may signal that the device is too large or has shifted out of its optimal position. A properly placed ring rests against the upper back wall of the vagina (the posterior fornix) and may gently encircle the cervix. This placement provides support without causing constant irritation to the sensitive lower vaginal tissues.
The goal of treatment is to alleviate symptoms; therefore, a device causing persistent awareness or localized discomfort is counterproductive. Some people may briefly feel the ring during strenuous activities, such as heavy lifting or intense exercise, due to increased intra-abdominal pressure. This sensation should be fleeting and should not represent ongoing irritation or pain. The absence of feeling is the best indicator that the ring is appropriately sized and seated.
Performing a Self-Check for Proper Placement
While a correctly seated ring pessary should be unnoticed during the day, a person should be able to locate it when actively checking its position with a finger. This self-check confirms the device has not migrated or rotated. Begin by thoroughly washing your hands with soap and water to prevent the introduction of bacteria into the vaginal canal.
Finding a comfortable position, such as standing with one foot on a chair or squatting, facilitates easy access to the vaginal opening. Gently insert one or two fingers into the vagina, aiming slightly upward and backward toward the tailbone. The ring pessary is a firm, smooth, circular or oval shape identifiable high up in the vaginal vault, usually several inches past the opening.
When the ring is in the right place, you should feel the smooth, rounded edge of the device, confirming it is present and properly oriented. The ring should feel secure, with its edges resting evenly against the vaginal walls without pressing sharply or uncomfortably. If the ring has a knob or fold (such as with a folding or support pessary), confirm that feature is also seated correctly, not protruding near the vaginal entrance.
The purpose of this active search is to confirm the device’s presence and stability, not to feel it constantly throughout the day. If you can easily reach the ring and it feels near the entrance, or if it feels tilted, this suggests a significant downward shift. If you are unable to locate the ring at all during a routine check, it may indicate that it has rotated or migrated deeper into the vaginal canal, necessitating follow-up with a healthcare provider.
Signs of Displacement or Complication
The presence of new or worsening symptoms often indicates a displacement or complication requiring medical evaluation. Persistent pain or soreness in the pelvic area, especially during sexual intercourse or when sitting, signals that the pessary is causing pressure or friction. This localized discomfort should prompt an immediate check of the device’s position.
Difficulty or changes in bladder or bowel function, such as straining to urinate or new constipation, can occur if the displaced ring is pressing on the urethra or rectum. Any change in vaginal discharge, particularly if it becomes foul-smelling, bloody, or significantly increases in volume, may signal a vaginal wall erosion or infection caused by the device. These symptoms warrant a healthcare consultation.
If the ring has slid down to the point where it is protruding from the vaginal opening, it is clearly displaced and must be addressed immediately to prevent further irritation or injury. Even if the ring is not protruding, a persistent sensation of the ring being too low or a feeling of something “falling out” suggests the device is no longer providing adequate support. When these abnormal signs occur, discontinue use and seek professional guidance rather than attempt to forcibly correct the position.