A pessary is a soft, removable medical device inserted into the vagina that provides support to the pelvic organs. This non-surgical option is primarily used to manage symptoms of pelvic organ prolapse, where organs like the bladder or uterus descend from their normal position. Pessaries also treat stress urinary incontinence, helping to prevent urine leakage during physical activities such as coughing, sneezing, or exercise. This guide outlines the steps and financial considerations for acquiring this device.
The Essential Role of Professional Consultation and Fitting
Acquiring a pessary begins with a professional consultation, as it is a medical device requiring a prescription. A healthcare provider, typically a Gynecologist, Urogynecologist, or specialized Nurse Practitioner, diagnoses the specific condition and its severity. This assessment determines if a pessary is a suitable and safe treatment option.
The fitting process involves a series of in-office trials to find the correct shape and size. The provider uses a sizing set to measure the vaginal space. A properly fitted pessary should not cause discomfort, should not be easily expelled when the patient strains, and must not interfere with bladder or bowel function.
Fitting is often a process of trial-and-error, sometimes requiring the patient to wear a trial size before a final selection is made. Follow-up visits are typically scheduled two to three weeks after the fitting to check the fit and ensure the device is not causing irritation or complications.
Types of Pessaries and Material Options
Pessaries come in a variety of shapes, each designed to address different anatomical needs and symptom severity. The Ring pessary is the most common style, often recommended for mild-to-moderate prolapse or stress urinary incontinence. For more advanced pelvic organ prolapse, space-filling pessaries such as the Gellhorn or the Cube are frequently selected.
The Cube pessary uses suction to hold its position, making it effective for severe prolapse, though it generally requires daily removal. The Gehrung pessary, which is U-shaped, is often customized to fit the user for conditions involving uterine or bladder prolapse. Selection is condition-specific and tailored to whether the patient needs simple or space-filling support.
The standard material for most modern pessaries is medical-grade silicone, which is pliable, soft, and non-absorbent. This material is favored because it is less likely to cause irritation or absorb odors compared to older materials like rubber or latex. A silicone pessary can last for several years with proper care before needing replacement.
Acquisition Channels: Retailers and Durable Medical Equipment Suppliers
The acquisition of a pessary is generally a direct medical process, as it is classified as Durable Medical Equipment (DME). Unlike over-the-counter items, a custom-fitted pessary is almost always ordered directly by the prescribing provider’s office. The prescription is sent for fulfillment to a specialized DME supplier or a hospital supply center, rather than a standard retail pharmacy.
The customized nature of a pessary often mandates the involvement of a DME vendor, even though a retail pharmacy may handle prescriptions for simple medical supplies. These specialized suppliers manage the medical billing process and offer a broader selection of the shapes and sizes required for fitting. Patients should inquire with their provider about which DME suppliers are in-network with their insurance plan.
In some cases, the provider’s office may keep a small inventory of common pessary types to dispense immediately after a successful fitting. However, most patients receive their permanent device through a direct order to a third-party medical supply company.
Financial Planning, Insurance Coverage, and Long-Term Care
Financial planning for a pessary involves costs beyond the initial purchase of the device itself. Since pessaries are classified as DME, coverage is determined by the Durable Medical Equipment benefits of an insurance plan, including Medicare and Medicaid. Patients should verify their specific coverage, as the copay or coinsurance for DME can differ from standard pharmacy benefits.
The out-of-pocket cost for the device without insurance typically ranges from $55 to $140, depending on the type and complexity. The largest financial component is often the initial fitting and subsequent professional visits, with the in-office procedure cost ranging from $100 to over $350. Patients on high-deductible plans may benefit from shopping around for the initial placement cost.
Long-term care covers the maintenance and replacement schedule. For patients who cannot remove and clean the device themselves, professional visits for cleaning and examination are required, typically every three to six months. Even for self-managing patients, a check-up every six months to a year is recommended to monitor vaginal health.
Silicone pessaries are designed to last for three to four years, but they require replacement if they show signs of wear or damage. Ongoing care also includes potential co-pays for vaginal estrogen cream, which is frequently prescribed to post-menopausal users to prevent vaginal wall irritation. Planning for these routine, recurring costs is necessary for successful long-term use.