Vaginal Pessaries: A Conservative Option for Pelvic Organ Prolapse

Pelvic organ prolapse (POP) affects millions of women worldwide, often impacting daily comfort, bladder or bowel control, and quality of life. While pelvic floor muscle training (PFMT) is a cornerstone of conservative management, vaginal pessaries offer an effective, low-risk option for symptom relief—particularly when used alongside physiotherapy.

What Is a Vaginal Pessary?

A vaginal pessary is a medical-grade silicone device inserted into the vagina to support the pelvic organs. Pessaries come in a range of shapes and sizes (e.g. ring, cube, Gellhorn) and can help reduce the sensation of vaginal heaviness, pressure, or bulging associated with POP.

Pessaries do not "fix" the underlying prolapse but provide mechanical support, allowing women to manage symptoms while continuing with other therapies such as PFMT.

Who Can Benefit?

According to the NICE Guideline NG123 (2019), pessaries should be offered as a conservative treatment option for women with symptomatic POP who do not wish to have surgery, are unfit for surgery, or are awaiting a surgical opinion.

Pessaries are particularly helpful for:

• Women with moderate to severe symptoms limiting daily function or exercise.
• Postpartum women seeking temporary support.
• Perimenopausal and menopausal women managing prolapse non-surgically.
• Those using physiotherapy who need support during exercise or rehabilitation.

The Role of Physiotherapy in Pessary Use

While pessaries are often fitted by doctors or nurses, pelvic health physiotherapists play a crucial role in pessary management:

• Assessment: A full pelvic floor and functional assessment can guide decision-making around suitability and support.
• Rehabilitation: Combining pessary use with a tailored PFMT program can enhance outcomes. With mechanical support in place, many women can train their pelvic floor muscles more effectively.
• Education: Physiotherapists educate patients on lifestyle adjustments, pressure management, and safe movement strategies while using a pessary.

A study by Bugge et al. (2017) found that over 70% of women using pessaries reported symptom relief, and many preferred them over surgery due to low risk and minimal disruption. Other recent reviews (Meriwether et al., 2019) have reinforced their safety and effectiveness in selected populations.

Safety and Considerations

Pessaries are generally safe, but proper fitting, hygiene, and follow-up are essential to avoid complications such as discharge or irritation. Many women can self-manage their pessary, while others may require regular check-ins with their healthcare provider.

Pessary use can be temporary or long-term, and for some, it may delay or completely avoid the need for surgery.

Takeaway

Pessaries are an underused but highly effective tool in managing POP. When combined with physiotherapy, they offer a holistic, empowering approach—relieving symptoms while supporting long-term pelvic floor rehabilitation.

If you're experiencing prolapse symptoms or want to explore all your options before considering surgery, talk to a pelvic health physiotherapist. You might be surprised at how much relief is possible with the right support.

References:

• NICE Guideline NG123: Urinary incontinence and pelvic organ prolapse in women: management (2019)
• Bugge C, et al. A pessary for pelvic organ prolapse: a study of effectiveness and women’s experiences. Int Urogynecol J. 2017;28(5):741–749.
• Meriwether KV, et al. Pessary use and fitting for pelvic organ prolapse: a review of indications, types, and complications. Obstet Gynecol Surv. 2019;74(5):293–301.