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Pessary Therapy: Types, Uses & Benefits

Pessary therapy is a non-surgical treatment for pelvic organ prolapse and urinary incontinence. A pessary is a medical device inserted into the vagina to provide support.

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Things worth knowing about "Pessary therapy"

Pessary therapy is a non-surgical treatment for pelvic organ prolapse and urinary incontinence. A pessary is a medical device inserted into the vagina to provide support.

What is Pessary Therapy?

Pessary therapy is a conservative, non-surgical treatment approach used primarily for pelvic organ prolapse and urinary incontinence. A pessary is a specially shaped medical device made from silicone or latex that is inserted into the vagina. It provides internal support to displaced pelvic organs and helps relieve symptoms such as involuntary urine loss, a sensation of pressure in the lower abdomen, or the feeling that something is falling out of the vagina.

When is Pessary Therapy Used?

Pessary therapy is recommended in the following conditions:

Uterine prolapse: The uterus descends toward or through the vaginal opening.
Vaginal wall prolapse (cystocele or rectocele): The front or back wall of the vagina collapses, often involving the bladder or rectum.
Stress urinary incontinence: Involuntary urine leakage triggered by physical activity, sneezing, or coughing.
Mixed urinary incontinence: A combination of stress and urge incontinence.
Desire to avoid surgery: For example, in older patients, those with elevated surgical risk, or women who wish to preserve fertility.

Types of Pessaries

Various pessary designs are available, and the most appropriate type is selected based on the individual anatomy and clinical findings of each patient:

Ring pessary: The most commonly used type, suitable for mild to moderate pelvic organ prolapse.
Cube pessary: Adheres to the vaginal wall through suction; suitable for more severe prolapse.
Dish pessary: Used for bladder prolapse, providing support from below.
Continence pessary (incontinence pessary): Designed specifically for stress urinary incontinence; applies targeted pressure to the urethra.
Gellhorn pessary: Suitable for severe prolapse, particularly after hysterectomy.

Fitting and Application

Pessary fitting is performed by a gynecologist, who determines the correct size and shape for each individual patient. Some pessaries can be inserted and removed by the patient herself on a daily basis (self-management pessaries). Others are fitted by a healthcare professional and require regular cleaning and follow-up visits – typically every four to twelve weeks.

To prevent vaginal dryness and irritation, topical estrogen therapy is frequently recommended alongside pessary use, particularly in postmenopausal women.

Effectiveness and Benefits

Clinical studies demonstrate that pessary therapy leads to a significant reduction in symptoms for many women. Key advantages compared to surgical intervention include:

No surgical procedure required
Fully reversible – the pessary can be removed at any time
Low risk of serious complications
Can serve as a bridge treatment before planned surgery
Suitable for use during pregnancy or when future pregnancy is desired

Possible Side Effects and Risks

If used incorrectly or without adequate follow-up, the following complications may occur:

Vaginal infections (colpitis)
Pressure sores or mucosal irritation
Abnormal discharge or unpleasant odor
In rare cases: erosion of the pessary into the vaginal wall (with very prolonged use without monitoring)

Regular gynecological check-ups are therefore an essential component of safe pessary therapy.

Pessary Therapy vs. Surgery

Pessary therapy does not permanently correct pelvic organ prolapse; rather, it provides symptomatic relief. In severe cases, or when conservative treatment proves insufficient, surgical reconstruction of the pelvic floor may be necessary. The decision between pessary use and surgery should always be made jointly by the patient and her gynecologist, taking individual circumstances and preferences into account.

References

German Society of Gynecology and Obstetrics (DGGG) – S2e Guideline: Genital Prolapse in Women (2016, revised 2021). Available at: www.awmf.org
Bugge C et al. – Pessaries (mechanical devices) for pelvic organ prolapse in women. Cochrane Database of Systematic Reviews, 2013. DOI: 10.1002/14651858.CD004010.pub3
Hagen S, Stark D – Conservative prevention and management of pelvic organ prolapse in women. Cochrane Database of Systematic Reviews, 2011. DOI: 10.1002/14651858.CD003882.pub4

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