A vaginal pessary is a soft, removable device placed in the vagina to support the pelvic organs. It is one of the two main conservative treatments for pelvic organ prolapse, the other being pelvic floor rehabilitation — and NICE recommends considering a pessary for women with symptomatic prolapse, alongside or before surgical options.
Pessaries are frequently under-offered. Many women are given a straight choice between "live with it" and "have surgery", with no mention of a device that has been in clinical use for well over a century and works well for a substantial proportion of those who try it.
This page explains what pessaries do, who they suit, and how they fit alongside physiotherapy. Fitting itself is carried out by an appropriately trained clinician — commonly a specialist gynaecology or continence service — and physiotherapy runs alongside it.
What a pessary does
A pessary sits inside the vagina and provides mechanical support to the vaginal walls and the organs behind them — bladder, uterus or rectum depending on the type of prolapse. It holds the tissue in a more anatomically normal position.
The effect on symptoms is often immediate and considerable: the dragging and heaviness reduce or disappear, the bulge sensation goes, and many women find they can return to exercise, work and activity they had given up.
What a pessary does not do is cure the prolapse. It manages it. Remove the pessary and the prolapse is unchanged. This is why it works best combined with pelvic floor rehabilitation, which addresses the muscular support itself — the pessary manages symptoms now, and the physiotherapy works on the underlying capacity.
Common types
Several designs exist, and the right one depends on your type and grade of prolapse, your anatomy and your lifestyle. Finding the right fit sometimes takes more than one attempt, which is normal.
Ring pessary
The most commonly used. A flexible ring, with or without support, suitable for many cases of uterine prolapse and cystocele. Often self-managed, which many women prefer.
Shelf and Gellhorn
Used for more advanced prolapse where a ring will not stay in place. Usually managed by a clinician rather than self-removed.
Cube and donut
Provide greater support through suction or bulk, for prolapse that other designs do not hold. Generally removed nightly.
Incontinence pessary
Shaped to support the urethra specifically, for stress incontinence rather than prolapse. Some women use one only for exercise.
How pessary use and physiotherapy work together
Symptom relief now, capacity later
The pessary removes the dragging and heaviness immediately. Pelvic floor rehabilitation builds the muscular support over three to six months. Neither replaces the other, and used together the results are better than either alone.
Being able to exercise again
Many women stop exercising because of prolapse symptoms, which reduces strength and worsens the underlying problem. A pessary frequently allows a return to training — which is precisely what the pelvic floor needs.
Pressure management
Chronic straining, constipation, chronic cough and poor lifting technique keep loading the prolapse. Addressing these protects both your own tissue and the effectiveness of the pessary.
Trialling before surgery
A pessary trial gives useful information before committing to an operation. If it relieves your symptoms, that suggests the prolapse is genuinely responsible for them — and if it does not, that is important to know before surgery.
A long-term option in its own right
Many women use a pessary for years and never need surgery. It is a legitimate destination rather than only a waiting room.
Practical realities
Honest points that are often not covered until after fitting:
- Follow-up is required. Pessaries need periodic review and cleaning — typically every four to six months if clinician-managed, and the interval is agreed at fitting.
- Self-management is often possible with ring pessaries, and many women prefer it: removing it at night or for intercourse, and cleaning it themselves.
- Discharge is common and usually manageable. New offensive discharge, bleeding or pain always needs review.
- Topical vaginal oestrogen is frequently prescribed alongside, particularly after menopause, because healthier tissue tolerates a pessary considerably better.
- Intercourse is possible with many pessary types, either left in place or removed beforehand depending on the design.
- The first fitting may not be the final one. Trying a different size or type is routine rather than a sign of failure.
- It can be removed at any time — nothing about a pessary trial is irreversible.
Contact your clinician promptly if you have pain, bleeding, offensive discharge, difficulty passing urine or opening your bowels, or if the pessary comes out and you cannot replace it.
Who it suits, and who it does not
Pessaries suit women who want to avoid or defer surgery, who are not fit for surgery, who are still completing their family — since prolapse repair is generally best deferred until after childbearing — and who want symptom control while working through pelvic floor rehabilitation.
They are less suitable where there is significant vaginal tissue thinning that has not been treated, active infection or ulceration, or where a woman is unable to attend the necessary follow-up. Very advanced prolapse can also make retention difficult, though specific designs exist for that.
If your prolapse has not been formally assessed and graded, that comes first. See prolapse physiotherapy for assessment, and your GP for referral to a urogynaecology or specialist continence service for fitting.
Frequently Asked Questions
What is a vaginal pessary?
It is a soft, removable device placed in the vagina to support the pelvic organs in women with pelvic organ prolapse. It provides mechanical support to the vaginal walls, which usually relieves the dragging, heaviness and bulge sensation. NICE recommends considering a pessary for symptomatic prolapse, alongside or before surgical options.
Does a pessary cure prolapse?
No — it manages the symptoms rather than correcting the underlying prolapse. Remove the pessary and the prolapse is unchanged. That is why it works best combined with pelvic floor rehabilitation, which addresses the muscular support itself. Many women use a pessary long term and never require surgery, which makes it a legitimate destination rather than only a temporary measure.
Is a pessary uncomfortable?
A correctly fitted pessary should not be felt at all. If you are aware of it, it is uncomfortable, or it causes pain or difficulty passing urine or opening your bowels, the size or type is wrong and needs adjusting. Trying more than one size or design before finding the right fit is routine.
Can I have sex with a pessary in?
With many types, yes — ring pessaries in particular can often be left in place during intercourse or removed beforehand and replaced afterwards. Some designs, such as shelf and Gellhorn pessaries, need to be removed. This should be discussed at fitting, and it is a reasonable factor in choosing which type suits you.
How often does a pessary need changing?
If it is managed by a clinician, review and cleaning is typically every four to six months, with the exact interval agreed at fitting. Many women with ring pessaries are taught to self-manage, removing and cleaning the device themselves — often nightly or weekly — which reduces the need for appointments and gives more control.
Should I try a pessary before considering surgery?
It is usually worth doing. A pessary trial is reversible, provides immediate symptom relief for many women, and gives useful diagnostic information: if it relieves your symptoms, the prolapse is likely responsible for them, and if it does not, that is important to establish before undergoing an operation. It is also the preferred option if you may have more children, since prolapse repair is generally best deferred until after childbearing.
Clinically reviewed by Jency Sudha, Consultant Pelvic Health Physiotherapist & Biofeedback Specialist — last updated 26 July 2026
The information on this page is for general guidance and does not replace individual clinical assessment. If your symptoms are new, worsening, or accompanied by bleeding, fever or severe pain, contact your GP or NHS 111.
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