She Came in Wanting to Garden Again.
One of my patients is an accountant. She also tends a large garden. It’s her hobby, the thing she comes home to after long hours at her desk. Or it was, until the pressure and bulging in her vagina got so constant that gardening became painful. Sitting at work was painful. Sitting anywhere was painful.
By the time she came to me, she had accepted that this was her new reality. She’d been told that prolapse like hers was something to live with, or surgery away. She wasn’t ready for surgery, but living with it was costing her everything she loved.
After her initial assessment, I knew that pelvic floor strengthening alone wasn’t going to be enough for her. Her anatomy, her tissue laxity, her degree of prolapse: the math didn’t work for muscle work alone. I didn’t want to waste months of her life trying to strengthen her way out of something that needed structural support.
So we got her fitted with a pessary. And she started strengthening. And within a few months, she was back in her garden, pain free, and sitting through long workdays without the constant pressure that had become her shadow.
That’s the case I think about every time someone asks me, “Wait, what’s a pessary?”
What Is a Pessary, Exactly?
A pessary is a small, flexible medical device, usually made of silicone or rubber, that’s inserted into the vagina to physically support the pelvic organs from the inside.
I tell my patients it’s essentially a splint for your vagina. The same way a knee brace stabilizes a joint that can’t hold itself together, a pessary holds the vaginal walls and surrounding structures in place when the natural support has weakened.
They come in many shapes and sizes (rings, cubes, donuts, dishes, gellhorns, Gehrungs) and the right type depends on:
- What kind of prolapse you have (anterior, posterior, uterine, vaginal vault)
- The severity of the prolapse
- Whether you have stress incontinence symptoms too
- Your anatomy and tissue characteristics
- Your lifestyle (active, sedentary, sexually active, etc.)
- Whether you want something you can manage yourself or one that’s placed and removed by a clinician
Who Benefits Most From a Pessary?
Two groups of women see life-changing results with pessaries:
Women with Pelvic Organ Prolapse
If you have pelvic organ prolapse, meaning your bladder, uterus, rectum, or vaginal walls are descending into the vaginal canal, a pessary lifts and supports those organs back into their normal position. Symptoms like:
- Pressure or heaviness in the pelvis
- A feeling like “something is falling out”
- A visible or palpable bulge
- Difficulty emptying your bladder or bowels completely
- Pain with sitting or prolonged standing
...can dramatically improve when the structures are physically supported. A pessary is the most studied conservative treatment for prolapse, recommended in clinical guidelines as a first-line option before surgery is considered. Read more about how we treat prolapse.
Women with Stress Urinary Incontinence
Some pessaries are designed specifically to support the urethra during physical activity, preventing leaking when you cough, sneeze, run, or jump. For women who leak only during specific activities (running, lifting, working out), a pessary can be inserted just for those activities and removed afterward.
This is particularly helpful for athletes, women returning to running postpartum, or women whose leaking is impacting their fitness routines. More on incontinence treatment.
Women in Pregnancy and Postpartum
Pessaries can be used during pregnancy for women with symptomatic prolapse, and they’re also helpful in the early postpartum period when tissues are still healing but symptoms are interfering with daily life.
Women Avoiding or Delaying Surgery
Some women aren’t surgical candidates due to age or health conditions. Others simply don’t want surgery if they don’t have to have it. Pessaries can be used long-term (many women wear them for years or even decades) or as a bridge while they consider their options.
Why Almost No One Has Heard of Pessaries
Pessaries have been used for over 4,000 years. They appear in ancient Egyptian medical texts. They’ve been part of women’s healthcare across nearly every culture and time period in human history.
And yet, in modern American medicine, most women have never heard of them.
Why? Several reasons converge:
- They’re not profitable. A pessary is a low-cost device. Surgery is an expensive procedure. The financial incentives in our healthcare system don’t favor a $50 silicone device over a $20,000 surgery.
- They’re considered “old fashioned.” Some providers see pessaries as outdated even though the research consistently shows they’re effective.
- Fitting them takes time. A 15-minute insurance-billed visit doesn’t accommodate a thorough pessary fitting.
- Many providers aren’t trained in fitting them. Pessary fitting is a specialty skill. If your OB-GYN didn’t learn it well in residency, they may simply not offer it.
- Surgical bias. The default treatment algorithm in many practices skips conservative options and goes straight to surgery for prolapse.
The result: women are presented with two options (suffer or have surgery) when a third, far less invasive option has existed all along.
How Pessary Fitting Actually Works
Pessary fitting is more art than science. Here’s what to expect from a thorough fitting:
A Typical Pessary Fitting
- Comprehensive assessment. Your clinician reviews your symptoms, examines your prolapse type and severity, and discusses your lifestyle.
- Initial sizing. Different pessary types and sizes are tried during the same visit until one feels right and stays in place comfortably.
- Functional testing. You stand up, walk around, cough, do squats, whatever is needed to make sure the pessary stays put during real life.
- Self-management training. If your pessary is one you can manage yourself, you’ll learn how to remove and reinsert it.
- Follow-up plan. Most patients return for a check within 1-2 weeks to make sure the fit is still comfortable, then less frequently after that. Check ups will typically happen around 6 months and again at a year to get a new one.
Fittings typically take 30-60 minutes. Some women find their fit on the first try. Others need a second appointment to try different sizes or types. Both are normal.
Pessaries and Pelvic Floor PT Work Together
This is the most important thing I want women to understand: a pessary is not a replacement for pelvic floor physical therapy.
The pessary provides external structural support. Pelvic floor PT addresses the underlying muscle dysfunction, coordination issues, breathing patterns, and movement habits that contributed to the prolapse or incontinence in the first place.
The two work together:
- The pessary lets you live your life and do your activities while you’re building strength.
- The strength work addresses the root causes that the pessary alone can’t fix.
- Some women eventually need the pessary less often as their muscle support improves.
- Others continue with both long-term and live full, active lives doing so.
My patient who got back to her garden didn’t just get fitted with a pessary and call it done. She also worked on her glute strength, her hip mobility, her breathing patterns, her lifting form, and how she managed pressure during gardening and prolonged sitting. The pessary plus the PT is what gave her her life back.
Common Concerns and Myths
“Won’t I feel it?” No. A properly fitted pessary should feel like nothing once it’s in. If you feel it, the size or type is wrong, and that’s a fixable problem.
“Will it fall out?” When fitted correctly, no. Your pelvic floor muscles still hold it in place. Most pessaries stay put through walking, exercise, intercourse (depending on the style), and daily life.
“Can I have sex with it in?” It depends on the type. Ring pessaries are typically left in during intercourse. Other styles (like cubes or gellhorns) need to be removed first. Your fitting clinician will recommend the right type for your lifestyle.
“Do I have to wear it forever?” No. Some women wear pessaries only during specific activities (exercise, work). Some wear them daily for years. Some wear them as a bridge while they decide on surgery or while doing PT to strengthen. The right pattern depends on you.
“Is it dirty or unhygienic?” No. With proper care (usually washing the pessary periodically and routine checkups with your fitting clinician) pessaries are safe for long-term use.
“If I get a pessary, does that mean my prolapse is permanent?” Not necessarily. Many women see significant improvement in their prolapse symptoms with PT and lifestyle changes. The pessary buys you time and quality of life while you address the root causes.
Is a Pessary Right for You?
You might be a good candidate for a pessary if:
- You’ve been told you have pelvic organ prolapse
- You experience pelvic pressure, heaviness, or a sensation that something is falling
- You leak during specific activities (running, lifting, jumping)
- You’re not ready for surgery, or you don’t want surgery
- You want to avoid or delay surgery while you try conservative options
- You’re pregnant and dealing with prolapse symptoms that are interfering with daily life
- You’ve been told to “just live with it”
You may not be a candidate if:
- You have active vaginal infections that need to clear first
- You have severe vaginal atrophy that hasn’t been treated
- You’re unable or unwilling to come back for periodic checkups
The only way to know for sure is to be assessed by a clinician trained in pessary fitting.
How Radiant Approaches Pessaries
At Radiant Pelvic Health, pessaries are part of a comprehensive treatment plan, not a standalone fix. We assess your prolapse type and severity, discuss the role a pessary could play, and help you understand the full picture, including how pelvic floor strengthening, breathing strategies, lifting form, and lifestyle changes work alongside the pessary.
Dr. Danaya is trained in pessary fitting. If a pessary is right for you, we can fit you with one during a physical therapy visit and include it as part of a comprehensive plan, no separate referral needed. If pelvic floor PT alone is enough for your situation, that’s the route we take. The goal is the right tool for your specific case, not a one-size-fits-all answer.
You Don’t Have to “Just Live With It”
If you’ve been carrying around pressure, heaviness, leaking, or pain because no one ever told you there was another option, this is your other option.
You don’t have to live with prolapse symptoms. You don’t have to rush into surgery. You don’t have to figure it out alone.
In Utah, you don’t need a referral to see a pelvic floor PT. Schedule a free 15-minute consultation and we can talk about whether a pessary, alongside pelvic floor PT, could give you back the things you’ve been missing.
