Gynaecology
Pessary clinic
You have been offered pessary treatment for management of vaginal prolapse symptoms. A pessary is essentially a removable vaginal device designed to support the pelvic organs, thus reducing symptoms of prolapse.
There are different types of pessaries that can be used depending on the type and severity of your prolapse. Most common are the Ring, Shelf, Gellhorn, POPY and Cube, however there are others available. They are used to support the tissues that have become weak and are safer than an operation. They are made of either silicone or vinyl.
Pessaries are usually easy to insert and should make you feel more comfortable by reducing the vaginal bulge or lump sensation related to prolapse.
It is not always possible to choose the correct size or shape immediately. Your doctor or nurse may need to try a different size or shape, until the best one with the most benefit is found.
After pessary insertion you will be asked to use the toilet and walk around, if you are comfortable and happy, you can go home. If not, another pessary can be fitted.
When your pessary fits comfortably you will be seen for follow-up in a nurse-led clinic, usually every 4 to 6 months, although this is individualised for each patient.
Possible complications of vaginal pessary use
- Vaginal discomfort.
- Vaginal discharge (that does not always mean infection).
- Bleeding due to pessary rub (but we need to check it is not from the womb lining).
- Flipped pessary (may be difficult to remove).
- Rarely retained pessary (may be difficult to remove, sometimes requiring anaesthetic).
- Very rarely fistula (abnormal communication between vagina and bladder or vagina and bowel resulting in incontinence of urine or faeces).
- Extremely rarely (chronic irritation of the vagina may lead to the development of abnormal cells in the vagina).
- You develop difficulty in passing urine or opening your bowels after pessary insertion.
- You experience severe discomfort.
- You notice any unexpected vaginal bleeding.
- Your pessary falls out.
What may happen after pessary fitting?
You may find that sometimes the pessary is visible or that you can feel it. This may occur after having your bowels opened due to straining and is not a problem. You will do yourself no harm by gently pushing it back in place. Indeed, you can support the pessary with your finger to stay inside when you are straining to open your bowels. We strongly recommend that you use laxatives and suppositories if you suffer from constipation, to make it unnecessary for you to strain.
Sometimes the pessary affects bladder function (either make you dry when you have previously been incontinent or the reverse). If your pessary has negatively affected your bladder function, you need to inform the consultant or nurse. If you suffer from new-onset incontinence, we can see you earlier in the clinic to discuss alternative treatments and remove the pessary if you wish or to discuss treatment for the incontinence whilst the pessary stays in place.
It is important that you avoid becoming constipated. If you find that a change of diet or extra fluids are not sufficient to maintain a regular bowel habit, then your GP may prescribe some medication to help prevent constipation.
If you have been through the menopause and feel soreness in the vagina, you may benefit from using vaginal oestrogen.
You can carry on your daily activities as usual including exercise.
How often should a pessary be checked or changed?
If you come to clinic to have your pessary removed, then the front passage will be checked at the same time. This usually takes place every 4 to 12 months. This is done for hygienic reasons and to make sure that the pessary has not caused any soreness to the delicate tissue in the vagina. It can be uncomfortable to remove and insert pessaries, but this is short lasting and for a few seconds only.
If all is well, the pessary will be replaced with a new one or may be washed and put back in the vagina every 4 to 6 months.
If you have been taught to self- manage your pessary, then we ask that you remove it, wash it and put it back in at least once (every 6 months for ring pessaries or daily in case of cube pessaries). Not all pessaries are suitable for self-management.
Sexual intercourse
This depends on the type of pessary; most couples are able to have satisfactory sexual intercourse with a ring pessary inside.
If you or your partner find that the ring pessary is getting in the way, you may want to be taught pessary self-management (how to insert and remove the pessary yourself). This will mean you can take the pessary out yourself prior to sexual intercourse and put back in afterwards. You will be offered a teaching session with the urogynaecology specialist nurse as well as regular follow-ups until you feel comfortable managing this on your own.
Other pessaries such as Shelf, POPY, Gellhorn or Cube pessaries are generally not compatible with sexual intercourse.
MRI scans
Some pessaries have a metal component and therefore will have to be removed prior to an MRI scan. The majority of pessaries are metal free and can be left in.
Useful links:
General advice
It is very important that you make every effort to attend for your clinic appointment. However, if you cannot attend for any reason, it is important to let us know so that your appointment time can be used by someone else, and we can arrange another appointment for you.
Please inform the appointments office on: 01642 282424
Advice lines
If you have any anxieties or questions relating to your appointment please do not hesitate to contact our advice lines:
- James Cook University Hospital: 01642 854243
- Friarage Hospital, Northallerton: 01609 764814
Email: [email protected]
Patient experience
South Tees Hospitals NHS Foundation Trust would like your feedback. If you wish to share your experience about your care and treatment or on behalf of a patient, please contact The Patient Experience Department who will advise you on how best to do this.
This service is based at The James Cook University Hospital but also covers the Friarage Hospital in Northallerton, our community hospitals and community health services.
To ensure we meet your communication needs please inform the patient experience department of any special requirements, for example; braille or large print by emailing: [email protected]