A pessary is a medical device, typically made of soft, flexible silicone, that a healthcare provider places inside the vagina to provide support to the pelvic organs. It is commonly used as a non-surgical treatment for conditions like pelvic organ prolapse, where organs such as the bladder or uterus have dropped, or to manage stress urinary incontinence. While an awareness of the device or a feeling of pressure is common, especially initially, a properly fitted pessary should not cause significant or sharp pain during regular use. The goal of a pessary is to alleviate discomfort and improve function.
Sensation During Insertion and Removal
The initial fitting begins with a pelvic examination to determine the correct size and type of device needed based on the individual’s anatomy and the extent of the prolapse. During insertion, most people report the primary sensation as pressure rather than pain, often comparable to the feeling of a routine speculum exam. The healthcare professional uses lubricant to ease the placement of the device into the vaginal canal.
Clinician technique plays an important role in minimizing acute discomfort. Once the pessary is placed, the professional ensures it is positioned correctly and then tests the fit by asking the patient to move, cough, or strain. The goal is a fit that provides support without causing pain or pressure, sometimes requiring multiple attempts with different sizes or shapes to achieve optimal comfort.
Removal, whether done by a clinician or by the patient for self-care, can sometimes be associated with more sensation than insertion. The feeling is usually a brief tugging or pressure as the device is gently manipulated and folded to slide out of the vagina. While some report a moderate sensation, this is momentary.
Identifying and Addressing Ongoing Discomfort
A correctly fitted pessary should not be felt during daily activities and should not cause persistent pain. If true pain develops after the initial fitting, it usually signals an issue requiring immediate attention from a healthcare provider. The most frequent cause of persistent discomfort is a poor fit, where the device is either too large or too small.
A pessary that is too large can exert excessive pressure on the vaginal walls, leading to constant discomfort, irritation, or abrasion, which may present as pink or bloody discharge. Conversely, a pessary that is too small may shift, fall out during activity, or rub against the vaginal entrance, also causing irritation. Finding the right fit is a trial-and-error process, and a change in size or shape can often resolve the pain.
Pain can also be a symptom of vaginal wall irritation or ulceration, especially in postmenopausal individuals whose vaginal tissues may be thinner due to lower estrogen levels. If the pessary is rubbing the same spot, it can create a sore or ulcer that causes localized pain and bleeding. In such cases, the provider may recommend temporarily removing the pessary to allow the tissue to heal and may prescribe a topical low-dose vaginal estrogen cream to improve tissue health.
Another source of pain or burning is a vaginal infection, which is sometimes indicated by a change in discharge, such as a foul odor or a yellow or green color. While increased clear or white discharge is common with a pessary, an infection requires a specific treatment, such as antibiotics, before pessary use can safely resume. If any ongoing pain, bleeding, or unusual discharge occurs, the patient should contact their healthcare provider immediately and, if trained, remove the device.