Pessaries are among the oldest medical devices still in use, with their origins tracing back to ancient Greece. Today, they remain a cornerstone in the conservative management of pelvic organ prolapse (POP), offering women a minimally invasive and effective alternative to surgery.
What Are Pessaries?
Pessaries are medical devices, usually made of silicone, that are inserted into the vagina to support areas affected by pelvic organ prolapse. Common types include ring pessaries (with or without central support), Gellhorn pessaries, and donut pessaries. These devices are widely used by gynecologists and urogynecologists, with over 86% and 98% of these specialists, respectively, incorporating them into daily practice.
Who Can Benefit from Pessary Use?
Pessaries are primarily used for women experiencing symptoms of pelvic organ prolapse, such as vaginal bulging, pressure, or urinary dysfunction. They are especially beneficial for:
- Women seeking to avoid or delay surgery
- Older adults or those with medical conditions making surgery risky
- Patients who wish to preserve fertility
- Women who prefer a non-surgical approach for personal or lifestyle reasons
Patient preference plays a significant role in treatment choice. Older women are more likely to opt for pessaries, while those with more severe symptoms or prior POP surgery may prefer surgical intervention. Sexually active women often lean toward surgery, but many also find pessaries compatible with their lifestyle.
Effectiveness and Quality of Life
Research consistently shows that pessary treatment is effective in alleviating the bothersome symptoms of POP, such as vaginal bulge and irritative bladder symptoms. Notably, studies using validated questionnaires—like the Pelvic Floor Distress Inventory (PFDI) and Pelvic Floor Impact Questionnaire (PFIQ)—demonstrate significant improvements in both symptom relief and overall quality of life following pessary use.
Women report high satisfaction rates, with medium-term use satisfaction ranging from 70% to 92%. Importantly, pessary use does not negatively impact sexual activity; in fact, some studies indicate improvements in sexual function, desire, and satisfaction after pessary treatment.
A recent comparative study even suggests that pessary treatment can be as effective as surgery in improving urinary, bowel, sexual function, and quality of life measures for women with symptomatic POP.
Fitting and Continuation Rates
Successful pessary fitting occurs in over 85% of cases. Factors that can make fitting challenging include short vaginal length, a large genital hiatus, prior hysterectomy, or previous POP surgeries. Continuation rates after 3–4 months of use range from 50% to 80%, and about half of women continue using a pessary for a year or more. Older age (above 65) and sexual activity are associated with longer-term use.
Potential Side Effects and Management
While pessaries are generally safe, some women may experience discomfort, vaginal discharge, or, less commonly, vaginal bleeding or erosion. Most issues can be managed with regular follow-up and proper hygiene. Rarely, women may develop new symptoms such as stress urinary incontinence, but these cases are the exception rather than the rule.
Pessaries offer a safe, effective, and patient-friendly option for managing pelvic organ prolapse. They provide significant symptom relief, improve quality of life, and are well-tolerated by most women. For those seeking a non-surgical solution, pessaries remain a valuable and time-tested choice.
If you are a healthcare provider interested in learning more about pessaries, please contact us. Our team is ready to provide detailed product information, training resources, and support to help you deliver the best care to your patients.
