A pessary is a silicone device inserted into the vaginal canal that provides mechanical support for pelvic organs that have descended from their normal positions. Unlike surgery, which corrects the structural defect that allows prolapse, a pessary works by providing a physical support structure within the vaginal canal that holds the prolapsed organ in a more normal position. It is removed, cleaned, and reinserted periodically — either by the patient at home or during office visits depending on the patient’s preference and ability.
Pessaries are available in a range of types and sizes. The most commonly used are ring pessaries, dish pessaries, and Gellhorn pessaries — each suited to different types and degrees of prolapse. Continence pessaries — rings with a knob or incontinence dishes — are specifically designed to provide urethral support for stress incontinence. The fitting process involves trialing the appropriate type and size to find a pessary that provides symptom relief while remaining comfortable for daily activities including exercise and intercourse.
A well-fitted pessary should not be felt during normal activities. When properly fitted and maintained, it provides symptom relief comparable to that of surgical repair for many women — and is the preferred management strategy for women who are not surgical candidates, who prefer to defer surgery, or who prefer non-surgical management indefinitely.
A pessary is an appropriate management option for a broad range of women with pelvic floor disorders. The following characterizes the patients for whom pessary fitting is most commonly recommended or considered.
- Women with pelvic organ prolapse (any compartment, any degree) who prefer non-surgical management
- Women who are not currently surgical candidates because of medical comorbidities, age, or current life circumstances
- Women who wish to maintain fertility and defer surgical repair
- Women who want to try non-surgical management before committing to surgery
- Women with stress urinary incontinence who prefer a mechanical option over surgery or pharmacologic management
- Women who want to manage leakage specifically during exercise or other high-demand activities
- Women with prolapse who are planning surgery but need symptom relief in the interim
- Postmenopausal women whose prolapse is mild to moderate and progressing slowly
- Women who have already had prolapse repair surgery and experience recurrence managed conservatively
The most important criterion for pessary candidacy is the presence of symptomatic pelvic floor dysfunction that a pessary can mechanically address. Most women with prolapse or stress incontinence are appropriate candidates for a pessary trial.
Ring Pessary — The Most Versatile Option
The ring pessary is a circular flexible silicone ring that fits behind the pubic symphysis and in the posterior vaginal fornix, providing support to the vaginal walls and reducing the descent of the bladder, uterus, or vaginal vault. It is the most commonly fitted pessary type for mild to moderate prolapse because of its versatility, comfort, and ease of self-management. Many women can insert and remove a ring pessary themselves, making it compatible with independent home maintenance.
Continence Ring and Dish Pessaries — For Stress Incontinence
Continence pessaries are ring or dish designs that incorporate a urethral support knob or elevated anterior portion that provides additional pressure beneath the urethra, mimicking the support effect that the midurethral sling provides surgically. They are specifically designed to reduce stress leakage and are fitted for women whose primary complaint is SUI rather than or in addition to prolapse.
Gellhorn Pessary — For More Significant Prolapse
The Gellhorn pessary is a more substantial device with a disc and stem design that provides greater apical and anterior support, making it suited for more advanced prolapse — including significant uterine prolapse or vaginal vault prolapse. It typically requires office insertion and removal and is most appropriate for women who prefer provider-managed maintenance rather than self-management.
Other Pessary Types
A range of additional pessary designs exists for specific anatomic situations, including cube pessaries for severe prolapse with poor vaginal tone, donut pessaries, and Shaatz pessaries. The selection of pessary type is made by Dr. Andrei based on the specific prolapse anatomy, the patient’s vaginal dimensions, and practical considerations around self-management. A pessary trial that does not succeed with the first type tried may succeed with a different type, and Dr. Andrei guides patients through this process systematically.
Pessary management at Lapeer Women’s Health is provided by Dr. Ramona D. Andrei, MD, PhD, FACOG — with an individualized fitting approach and a follow-up plan that ensures ongoing comfort, effectiveness, and vaginal tissue health.
Initial Fitting
The fitting visit involves a pelvic examination to assess the type and degree of prolapse, followed by trial fitting of the most appropriate pessary type and size. The goal is a pessary that provides symptom relief, cannot be felt during normal activity, and does not fall out with Valsalva or position change. Women are asked to move around and strain during the fitting visit to assess pessary retention before leaving the office.
Self-Management Training
For women using ring or other self-manageable pessary types, Dr. Andrei and our clinical staff provide instruction in pessary insertion and removal at the fitting visit. Self-management allows women to remove the pessary for cleaning and intercourse on their own schedule without requiring office visits for routine maintenance. Women who prefer provider-managed maintenance schedule periodic office cleaning visits instead.
Follow-Up and Ongoing Care
Follow-up is scheduled at two to four weeks after fitting to assess comfort, symptom relief, and vaginal tissue health. Annual follow-up visits for pessary check and vaginal assessment are standard for women on ongoing pessary management. Local vaginal estrogen is recommended for most postmenopausal women using a pessary to maintain the vaginal tissue health that reduces pessary-related irritation and discharge.
One of the most underappreciated aspects of pessary management is the combination of meaningful symptom relief and minimal disruption. A well-fitted pessary eliminates or significantly reduces pelvic pressure, urinary leakage, and prolapse symptoms without surgery, without recovery, and without time away from work, family, or physical activity. For many women — particularly those in physically active phases of life, those deferring surgery, or those who simply prefer non-surgical management — it is an ideal long-term solution.
Dr. Ramona D. Andrei and the team at Lapeer Women’s Health provide pessary fitting as part of a comprehensive pelvic floor evaluation — at both our Lapeer and Rochester Hills offices, without a referral required.
Pessary Treatment
Our team at Lapeer Women’s Health provides expert pessary fitting and ongoing management at both our Lapeer and Rochester Hills offices. No referral required.
Schedule a Gynecologic VisitThe information on this page is intended for educational purposes only and does not constitute medical advice. Content reviewed by Dr. Ramona D. Andrei, MD PhD FACOG.
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Lapeer Women’s Health — Rochester Hills
2710 S Rochester Rd, Suite 2
Rochester Hills, MI 48307
Serving patients in Lapeer, Rochester Hills, and surrounding communities throughout Southeast Michigan.