Pessaries: A Non-Surgical Solution for Pelvic Support

Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026

A pessary is a removable device, usually made of soft silicone, that is inserted into the vagina to support the pelvic organs. It can ease the symptoms of pelvic organ prolapse and stress incontinence without surgery [1]. With several shapes available, including ring and space-filling designs, most users can find a comfortable fit through a professional fitting and simple home care [1].

Quick Answer: What is a pessary?

A pessary is a device inserted into the vagina to support pelvic organs such as the uterus, bladder and rectum, used to treat pelvic organ prolapse or stress incontinence. It reduces vaginal fullness and urine leakage. Many people choose it to avoid surgery. Fitting may take two or three attempts, and regular follow-up visits are needed. [1]

What the research says

• About three-quarters of women who were successfully fitted were still using a pessary after 5 years. In a prospective study of 312 women with symptomatic prolapse, 265 (84.9%) were successfully fitted, initially with a ring pessary and a Gellhorn pessary if the ring failed. After 5 years, 180 of 239 followed patients continued use (75.3%). Discontinuation fell from 8.7% at 1 year to 2.7% at 5 years, and a short vaginal length (under 7.5 cm) and being unable to manage self-care were potential risk factors for stopping (Ma et al., Menopause, 2021).

• In a large US registry, 62% were still using a pessary at 1 year. Of 1,153 women with prolapse, 376 (32.6%) chose a pessary and 296 (78.7%) were successfully fitted. At 1 year, 62% of those with data were still using pessaries and 38% had stopped. The most common new problems were urinary leakage (16%), a bulge (12%), and vaginal discharge (11%), and complication rates were low (Yurteri-Kaplan et al., Urogynecology, 2022).

• Most women who stop using a pessary do so in the first year. In a prospective study of 277 women with successful fittings, 76.5% still used a pessary at the end of follow-up (median 26 months). Of the 61 who stopped, 55 (90.2%) stopped within the first 12 months (Mao et al., Climacteric, 2019).

Research summaries are based on article abstracts retrieved from PubMed.

When are pessaries used for pelvic support?

The main reasons to use a pessary are symptom relief and avoiding or delaying surgery. The table shows who typically benefits [1].

Condition	Primary Symptoms	Pessary Benefit
Pelvic organ prolapse	An unpleasant fullness in the vagina; with severe prolapse, an organ that can be felt poking out.	Holds organs in place and reduces pressure.
Stress incontinence	Dribbling urine or accidents when you laugh, cough, sneeze, or exercise.	Supports the urethra to prevent leakage.
Surgical alternative	A wish to avoid surgery, or medical problems that make surgery too risky.	Provides symptom relief without surgery.
After other treatments	Symptoms continue after pelvic floor exercises and physical therapy.	Offers another conservative option.

What types of pessaries are available?

Pessaries come in different shapes and sizes, and most are made of safe, nonabsorbent soft silicone. Choosing the right type is important for both comfort and effectiveness [1].

Support Pessaries

The ring pessary is an O-shaped device that most healthcare providers recommend for stress incontinence and mild to moderate prolapse. It is the easiest type to care for on your own [1].

Space-Filling Pessaries

For advanced prolapse, the Gellhorn pessary is usually the go-to option. It is disk-shaped with a knob in the center and fills the upper part of the vagina, creating a barrier that prevents pelvic organs from slipping into the vaginal canal. The donut and cube pessaries are often used as alternatives [1].

Other Shapes

Your provider may fit you with other types, including the Shaatz (disk-shaped without the knob) and the Gehrung (U-shaped with a rubber membrane, especially useful for uterine or bladder prolapse) [1]. Some pessaries for stress incontinence are available over the counter, but most need an in-office fitting [1].

Pessary Type	Common Shape	Primary Use Case
Ring	O-shaped ring	Stress incontinence; mild to moderate prolapse.
Gellhorn	Disk with a central knob	Advanced pelvic organ prolapse.
Donut	Like the ring but thicker	Alternative to the Gellhorn for advanced prolapse.
Gehrung	U-shaped with a rubber membrane	Uterine or bladder prolapse.
Cube	Cube with concave sides that suction to the vaginal walls	Alternative to the Gellhorn for advanced prolapse.

How is a pessary fitted and cared for?

A pessary fitting starts in a healthcare setting, and successful use also depends on cleaning and follow-up care. At the visit, your provider will [1]:

1. Perform a pelvic exam to measure the vaginal opening and canal and judge the severity of prolapse.

2. Choose the type and size. A pessary that is too small may fall out when you use the bathroom, and one that is too big may be uncomfortable. The goal is a pessary that stays in place but that you do not feel.

3. Place the pessary, with lubricant or numbing lidocaine if you are concerned about discomfort.

4. Test that it works. You may stand, sit, squat, or cough to check that it stays put and that you are not leaking. You should be able to urinate with the pessary in.

Cleaning and Follow-Up

• Removable pessaries: a ring pessary or another type you can remove can be washed weekly or even nightly. Wash your hands, gently pull the pessary out, wash it with mild soap and water, then rinse and dry it completely before reinserting [1].

• Pessaries you cannot remove: these can stay in for a few months, and you need to see your provider every three to six months for cleaning and a checkup [1].

• Long-term monitoring: follow-up visits every six to 12 months let your provider check that the pessary is not scraping or bruising the vaginal walls [1].

What are the risks and considerations of using pessaries?

A pessary is a safe treatment with minimal risks, but pain, pink or bloody discharge, or unusual discharge and odor can signal a fit problem or infection. Signs to look out for include [1]:

• Pain or discomfort: this usually means the pessary does not fit correctly and you likely need a different size.

• Pink or bloody discharge: this is a sign the pessary is rubbing against the vaginal wall. You may need a different size, a short break from the pessary to let the skin heal, or a low-dose vaginal estrogen to improve the health of the vaginal skin.

• Unusual discharge and odor: white discharge is normal with a pessary, but an unpleasant odor signals an infection that may need antibiotics.

Pessaries are not for everyone. Finding the right fit can take trial and error, they need regular provider visits, space-filling types must be removed for intercourse, and they do not work for everyone. Some people with stress incontinence report better results with Kegel exercises, and some people eventually need surgery [1].

Pessary or Surgery?

The answer depends on the person. A pessary often gives enough symptom relief to avoid more invasive treatment, but it may not work if prolapse is severe. Some studies show that both options improve symptoms of advanced prolapse, while surgery may provide more long-term satisfaction. Surgery may be a better option if you cannot attend the follow-up visits that a pessary requires. Your provider can help you weigh the pros and cons [1].

Conclusion

Pessaries provide a reliable, non-surgical way to manage pelvic organ prolapse and stress incontinence. By supporting the pelvic organs, they can improve quality of life and restore a feeling of control [1]. If you have pelvic pressure or urinary leakage that interferes with daily life, talk with a healthcare provider about whether a pessary is right for you.

When should you call the doctor about pessaries?

Contact your healthcare provider if you have pain or discomfort or notice an abnormal, foul-smelling discharge. You may need to be refitted, or you may need treatment for an infection [1].

Frequently Asked Questions

What exactly is a pessary?

A pessary is a removable device, usually made of soft silicone, that you or your healthcare provider inserts into the vagina to support pelvic organs that have slipped out of place [1].

Can a pessary help with urinary leakage?

Yes. A pessary can help manage stress incontinence, which is leaking urine when you laugh, cough, sneeze, or exercise. Some pessaries for stress incontinence are available over the counter and support the urethra so urine does not dribble out [1].

How do I know which size I need?

A healthcare provider determines the type and size during an in-office fitting and pelvic exam. The size of the vaginal opening, the length of the vaginal canal, and the severity of prolapse all play a role [1].

Is the fitting process painful?

The fitting involves a pelvic exam and gentle insertion. Your provider can lubricate the pessary or apply lidocaine to numb the vaginal opening if you are worried about discomfort [1].

Can I feel the pessary once it is inside?

The goal is a pessary large enough to stay in place but comfortable enough that you do not feel it. Pain or discomfort usually means the fit is wrong and you likely need a different size [1].

How often should I clean my pessary?

If you can remove it yourself, such as a ring pessary, you can clean it weekly or even nightly. If you cannot remove it, you need to see your provider every three to six months for cleaning and a checkup [1].

Can I have sex while wearing a pessary?

Smaller ring pessaries can be worn during intercourse, although some people remove them first. Space-filling types such as the Gellhorn, donut, and cube must be removed before sex, and many people need a provider to remove and reinsert them [1].

What are the signs of a poor fit?

A pessary that is too small may fall out when you use the bathroom, and one that is too big can be uncomfortable. Pain, or pink or bloody discharge, can mean the pessary is rubbing and you need a different size [1].

Are there any serious risks?

A pessary is a safe treatment with minimal risks. Watch for pain, pink or bloody discharge, or an unpleasant vaginal odor, which signals an infection that may need antibiotics. Contact your provider if any of these occur [1].

Can a pessary be used as a long-term solution?

Yes, many people use a pessary long term, and in research most women who are successfully fitted keep using one for years. It may not work for everyone, and some people eventually need surgery [1] [2].

Related Resources

External resource for deeper reading:

• Cleveland Clinic. Pessary. Cleveland Clinic Health Library. Last updated December 26, 2023. https://my.clevelandclinic.org/health/treatments/16036-pessaries

Related Reading

Pelvic Organ Prolapse: What It Is, the 4 Types, and How It’s Treated explains pelvic organ prolapse types and treatment options.

Stress Incontinence: Symptoms, Causes, and Treatment Options Explained covers leaking with coughs or sneezes and how it is treated.

Uterine Prolapse: What It Is, Symptoms, Causes, and Treatment Options describes a dropped uterus and when a pessary or surgery helps.

Pelvic Floor Muscles: Anatomy, Function, Dysfunction and Care explains how pelvic floor muscles work and how to strengthen them.

References

1. Cleveland Clinic. Pessary. Cleveland Clinic Health Library. Last updated December 26, 2023. https://my.clevelandclinic.org/health/treatments/16036-pessaries

2. Ma C, Zhou Y, Kang J, et al. Vaginal pessary treatment in women with symptomatic pelvic organ prolapse: a long-term prospective study. Menopause. 2021;28(5):538-545. PMID: 33625108. DOI: 10.1097/GME.0000000000001751

3. Yurteri-Kaplan LA, Meyn L, Moalli PA, et al. Outcomes of pessary use at 1 year in women treated for pelvic organ prolapse in a large multicenter registry: developed by the Pelvic Floor Disorders Registry. Urogynecology (Phila). 2022;28(12):800-810. PMID: 36409637. DOI: 10.1097/SPV.0000000000001279

4. Mao M, Xu T, Kang J, et al. Factors associated with long-term pessary use in women with symptomatic pelvic organ prolapse. Climacteric. 2019;22(5):478-482. PMID: 30897024. DOI: 10.1080/13697137.2019.1582623

Medical disclaimer

This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have about a medical condition.