Self-management of a pessary for pelvic organ prolapse

You have been given this leaflet because your doctor thinks you can benefit from learning to take out and replace your own pessary for pelvic organ prolapse (POP).

What is a pelvic organ prolapse (POP)?

A POP is a bulge coming into the vagina. It can occur when there is a weakness in the walls of the vagina causing the bladder, bowel or uterus (womb) to protrude. You may experience a heaviness, dragging or a sensation of ‘something coming down.’ A POP can also cause bladder or bowel problems, such as incomplete emptying. It can also interfere in sexual activity. A POP can occur when the muscles, ligaments or tissues cannot support everything in the pelvis. Risk factors include childbirth, aging, a family history or repetitive straining on the pelvis such chronic coughing, a history of constipation, being overweight and repetitive heavy lifting. A pessary can help reduce the symptoms of a POP.

Why should I do this?

It will give you more independence and allows you to take out the pessary more often to suit your own lifestyle. It will also reduce the number of times you need to visit hospital or your GP. Many women say they feel cleaner as the pessary can be removed more often and washed more frequently.

What happens next?

A women’s health physiotherapist or specialist nurse will teach you how to take out and replace the pessary. The pessary can be taken out as often as you like. Some women find they do not need to wear the pessary all the time. You may wish to take it out before bedtime, or even before having sex, if you are sexually active. If you have problems with the pessary you can contact the hospital. Contact details are at the end of this leaflet.

If you have a PVC ring or Falk pessary you will need a new one when it is twelve months old. If you have a silicone pessary you will not need a new one until it is five years old. You can throw away the old pessary. We recommend a yearly review appointment with the clinic for replacement pessaries and a check up.

How do I take out my pessary?

Wash your hands and find a comfortable position (you do not need to wear gloves). Insert a finger inside the vagina and hook your finger over the pessary and pull. Some women find it easier if you cough at the same time. You may notice some discharge or slight bleeding. This is normal. Wash the pessary in warm water before replacing it.

When removing the cube pessary, locate the pessary using the silicone string. Do not pull on the string. Sweep a finger around the pessary to break the suction. Eases the pessary down the vagina using a finger. When the pessary is close to the entrance of the vagina, use your thumb and index finger to pinch the pessary and pull the pessary out.

How do I insert my pessary?

Wash your hands and get into a comfortable position. This can be lying down, squatting or one foot up on a chair, stool or bed.

PVC Ring Pessary

Twist the ring into a figure of eight as shown in the photo or bend it in half. Put lubricant (for example KY jelly) on the top of the pessary or at the entrance of the vagina and keep it in this shape in one hand.

Silicone Ring

Fold the ring in half as shown in the photo. Put lubricant (for example KY jelly) on the top of the pessary or at the entrance of the vagina, and keep it in this shape on one hand.

Silicone Cup Pessary

Fold the pessary in half. Put lubricant (for example KY jelly) on the top of the pessary or at the entrance of the vagina and keep it in this shape in one hand.

Falk Pessary

Fold the pessary as shown. There is a soft part of the pessary to bend. Put lubricant (for example KY jelly) on the top of the pessary or at the entrance of the vagina and keep it in this shape in one hand.

Cube Pessary

Hold the cube pessary between the thumb and index finger. Compress and insert inside the vagina. The cube pessary must be removed daily.

With the other hand separate any folds of skin. Put the pessary inside the vagina. Hold the pessary until most of it is inside. Start to let the pessary unfold. If needed, push the rest of the pessary in with your other hand before you let go completely. Sometimes it needs to be pushed inside a little further. The physiotherapist or nurse will check you can do this before going home.

What should I look out for?

A small amount of bleeding whilst changing the pessary is normal. If you experience bleeding when you are not changing your pessary, heavy bleeding or excessive discharge you should contact your healthcare professional.

What happens if I have problems changing my pessary?

You can contact the physiotherapist, nurse or consultant secretary by phone if you experience problems. Please leave a message on any answer machine and note you might not get a response immediately.

Physiotherapist 01223 217422

Specialist nurse 01223 349239

Consultant secretary 01223 586740

If you have urgent concerns you can contact your GP or call Daphne Ward on 01223 217636. The ward opening hours are: Monday – Friday 08:00‑20:00 and Saturday and Sunday 08:30-14:00.

The physiotherapist or nurse will document your type, size and first replacement date below. You may find it useful to keep a note when you last removed and replaced the pessary.

Type of pessary ____________Size ________ Replacement date________