Tips & Tricks: Mastering Vaginal Pessary Insertion & Removal

Have you ever wondered how vaginal pessaries work and how to use them effectively? In this article, we’ll explore the essential techniques for inserting and removing vaginal pessaries. Whether you’re a healthcare professional or someone considering using a pessary yourself, understanding these tips and tricks will empower you to make informed decisions and ensure optimal results.

Before You Begin

Before offering a vaginal pessary, it’s crucial to confirm that the patient doesn’t have any contraindications. These include known genital tract malignancy, unexplained vaginal bleeding, or severe vaginal atrophy. Additionally, it’s important to ensure the patient is willing and able to comply with follow-up care. Taking the time to understand the patient’s sexual activity and preferences will also help in selecting the most appropriate pessary. For patients who will be self-managing the pessary, assessing manual strength and dexterity is crucial to ensure successful use.

Finding the Perfect Fit

Pessary fitting is a process of trial and error, requiring patience and persistence. The goal is to find a pessary that relieves symptoms without causing discomfort or interfering with normal bodily functions. To determine the correct size, a vaginal examination is performed. Using the index and middle finger, the healthcare provider estimates the distance between the posterior fornix and pubic symphysis and measures the vaginal width. These measurements serve as a guide for selecting the initial pessary size. It’s important to follow the manufacturer’s instructions regarding pessary care, as some may require washing before use.

Smooth Insertion Techniques

To ease the insertion process, many pessaries are designed to be foldable. Ring pessaries, for example, can be folded in two or into a figure 8 shape to reduce their diameter. If you encounter difficulty bending the pessary, running it under warm water can make it more manageable. In post-menopausal women, applying an oestrogen-based cream can further aid insertion and reduce the risk of abrasions. Insert the pessary vertically into the vagina, then release it to assume a horizontal position. A properly sized pessary should allow a finger to be comfortably passed around its circumference. After insertion, ask the patient to walk around and empty their bladder to check if the pessary stays in place and doesn’t cause any discomfort. If the pessary is expelled while walking, it may be too small, while obstruction of urination suggests it may be too large. Before leaving the healthcare facility, the patient should be educated on how to remove the pessary correctly if any discomfort arises. They should also be informed about the possibility of increased vaginal discharge, especially if using an oestrogen cream concurrently. Provide the patient with a contact number for the healthcare unit in case of pain, expulsion, or signs of infection.

Effortless Removal Techniques

Removing a pessary is usually simpler than inserting one. For ring pessaries, hooking a single finger under the rim and gently pulling it down towards the rectum while keeping it folded can facilitate removal. When encountering difficulty, asking the patient to bear down and using a Cusco speculum to locate the pessary can be helpful. Grasping the stem of the pessary with sponge-holding forceps can aid in removal. Pessaries rely on a suction seal to stay in place, so breaking this seal can facilitate removal. Inserting a finger under the rim or squirting warm water into the stem of the pessary with a syringe are alternative methods that can help with removal.

With these tips and tricks, you can navigate the world of vaginal pessaries with confidence. Remember to consult with your healthcare provider for personalized guidance. For more information, visit