A vaginal pessary is a removable medical device placed inside the vagina to support organs that have dropped out of position due to pelvic organ prolapse. Around one in twelve women in the UK will experience prolapse at some point, and a pessary is often the first treatment offered, whether as a long-term alternative to surgery or a temporary measure while waiting for an operation. This guide covers the main pessary types used in UK practice, how fitting works, which sizes are available, and how to care for a pessary at home.
In this article
- What is a vaginal pessary and how does it work?
- What are the different types of pessary?
- Pessary types compared: which one is right?
- What sizes do pessaries come in?
- How is a pessary fitted?
- Can you manage a pessary yourself?
- What does the evidence say? The TOPSY trial
- How do you care for a pessary?
- What problems can a pessary cause?
- PVC vs silicone pessaries: what is the difference?
- Frequently asked questions
What is a vaginal pessary and how does it work?
A vaginal pessary is a device made from medical-grade silicone or PVC that sits inside the vagina to hold pelvic organs in their correct position. Pessaries are used to treat pelvic organ prolapse, a condition where the bladder, uterus, or bowel drops down and presses against or through the vaginal wall.
Prolapse happens when the pelvic floor muscles and supporting tissues weaken. Common causes include pregnancy and childbirth, ageing, menopause (when oestrogen levels fall), obesity, chronic coughing, heavy lifting, and previous pelvic surgery. NICE estimates that up to 50% of women who have given birth have some degree of prolapse, though many experience no symptoms.
A pessary works by providing mechanical support. Depending on the type, it either sits across the vagina like a shelf, fills the vaginal space, or creates gentle suction against the vaginal walls. Most women cannot feel a correctly fitted pessary during daily activities, including walking, exercise, and cycling.
Pessaries are offered as a first-line treatment on the NHS. They suit women who want to avoid or delay surgery, are not well enough for an operation, are planning future pregnancies (when prolapse may recur after surgical repair), or prefer a reversible, non-surgical option. A pessary can also be used as a temporary measure while waiting for surgery.
What are the different types of pessary?
UK gynaecology clinics use six main types of pessary. The ring pessary is by far the most common starting point, but clinicians may move to other designs when a ring does not stay in place, does not relieve symptoms fully, or is not suitable for the type or severity of prolapse.
Ring pessary
A ring pessary is a circular device that sits across the vagina, resting on the bony ledge behind the pubic bone at the front and in the posterior fornix (behind the cervix) at the back. Ring pessaries come in PVC and silicone versions. PVC rings are single-use and replaced at each clinic visit, typically every six months. Silicone rings can be washed and reused, and some contain a flexible spring core that makes them easier to fold for insertion and removal. Folding silicone rings have notches that allow the ring to collapse into a figure-of-eight shape.
Ring pessaries are suitable for anterior (front wall) prolapse, posterior (back wall) prolapse, uterine prolapse, and vault prolapse after hysterectomy. They tend to work best for mild to moderate prolapse. Most women can have intercourse with a ring pessary in place, though a partner may feel it.
Variations include the ring with knob, which adds a small bump that sits behind the pubic bone to support the bladder neck in women who also have stress urinary incontinence, and the ring with support membrane, which has a flexible diaphragm with drainage ports across the centre for extra support in more significant uterine prolapse.
Gellhorn pessary
A Gellhorn pessary has a flat circular plate (the base) with a central stem. The plate creates suction against the vaginal walls, providing stronger support than a ring. Gellhorn pessaries are made from flexible silicone and come in standard and short-stem versions. The shorter stem suits women with a shorter vaginal canal.
Gellhorn pessaries are used for moderate to severe prolapse, including significant uterine descent, and are often tried when a ring has not stayed in place. They are generally not compatible with penetrative intercourse unless the woman removes and replaces the device herself.
Shelf pessary
A shelf pessary is kidney-shaped with a curved central stem. It provides strong support for advanced prolapse and is available in rigid acetyl copolymer (hard plastic) or compressible silicone. The rigid version offers the most support but is harder to insert and remove. It is not suitable for women who are sexually active.
Donut pessary
A donut pessary is a thick, rounded device that fills the vaginal space. It is made from flexible silicone and is used for severe prolapse, especially with a uterus present or with a large genital hiatus (a wide vaginal opening). Donut pessaries are effective but can be harder to insert and remove than a ring.
Cube pessary
A cube pessary has six concave sides that create suction for retention. It is used for severe prolapse where other pessaries have failed. Cube pessaries must be removed and cleaned every night, so they require good manual dexterity. A tandem cube (with ten concave sides) is available for women who cannot retain the largest standard cube.
Inflatable pessary
An inflatable pessary is inserted in a deflated state, then expanded using a small hand pump. A bead on the stem controls inflation and deflation. It must be removed, cleaned, and reinserted daily and should not be left in for more than 24 consecutive hours. Some versions contain latex, so women with a latex allergy should choose a silicone model.
Pessary types compared: which one is right?
The table below summarises the key differences between the six main pessary types used in UK clinics. Your clinician will recommend the most appropriate type based on the severity and location of your prolapse, your vaginal anatomy, whether you are sexually active, and your ability and willingness to manage the pessary yourself.
| Type | Best for | Intercourse possible? | Self-management | Removal frequency | Material |
|---|---|---|---|---|---|
| Ring | Mild to moderate prolapse (any wall) | Yes | Often suitable | Every 6 months (clinic) or as needed (self) | PVC or silicone |
| Gellhorn | Moderate to severe prolapse | Remove first | Possible for some | Every 3 to 6 months | Silicone |
| Shelf | Advanced or recurrent prolapse | Remove first | Less practical | Every 3 to 6 months | Rigid plastic or silicone |
| Donut | Severe prolapse, large genital hiatus | Remove first | Difficult | Every 3 to 6 months | Silicone |
| Cube | Severe prolapse (last resort) | Remove first | Required (daily removal) | Every night | Silicone |
| Inflatable | Variable prolapse or comfort preference | Remove first | Required (daily removal) | Every night | Silicone or latex |
What sizes do pessaries come in?
Pessary sizes are measured by outer diameter in millimetres. The correct size is determined by trial and fit during the clinic appointment, not by any external measurement. A pessary that is too small will fall out; one that is too large will cause discomfort or difficulty passing urine.
| Pessary type | Smallest (mm) | Largest (mm) | Typical increments |
|---|---|---|---|
| PVC ring (e.g. Portia) | 50 | 110 | 3 mm |
| Silicone ring (e.g. Milex) | 51 | 127 | 6 to 7 mm |
| Gellhorn | 38 | 95 | 6 to 7 mm |
| Shelf | 38 | 102 | Varies |
| Donut | 51 | 95 | Varies |
| Cube | 25 | 75 | Varies |
Most NHS clinics stock PVC ring pessaries in 3 mm increments across the full range. Silicone rings and specialist pessaries are available in numbered sizes (the Milex range runs from Size 1 at 51 mm to Size 13 at 127 mm). Your clinician may try several sizes during the fitting appointment to find the best fit.
Single-use PVC ring pessary, 12.5 mm cross-section. Available in 50 mm to 110 mm. The same type used in most NHS gynaecology clinics.
How is a pessary fitted?
Pessary fitting is done in a gynaecology outpatient clinic by a doctor, urogynaecology nurse specialist, or specialist practitioner. The process typically takes 15 to 30 minutes and does not require anaesthesia.
What to expect during fitting:
- You will undress from the waist down and lie on a couch with your knees bent and legs apart.
- The clinician performs a vaginal examination (and sometimes a speculum examination) to assess the type and severity of prolapse and estimate the pessary size needed.
- The pessary is coated with lubricant or oestrogen cream, then folded or compressed and inserted into the vagina.
- The clinician positions the pessary so that the front edge sits behind the pubic bone and (if the cervix is present) the back edge sits behind the cervix.
- You may be asked to stand up, cough, and bear down to check the pessary stays in place.
- If the pessary is uncomfortable or slips out, a different size or type will be tried.
Finding the right fit may take more than one attempt. Some women need to return for a second appointment with a different size. There is no reliable way to predict the correct size from an external measurement, so fitting is always done by trial.
After the initial fitting, you will usually be seen for a check at three months, then every six months. At each visit, the old pessary is removed, the vaginal walls are examined for any irritation or ulceration, and a new pessary is fitted.
Can you manage a pessary yourself?
Yes, and for many women self-management is a better option than clinic-only care. Self-management means learning to remove, clean, and reinsert your own ring pessary at home, so you do not need to attend a clinic every six months for a routine change. Your clinician or urogynaecology nurse will teach you the technique.
How self-management works:
- Hook a finger over the front edge of the ring and bring it down gently.
- Compress the ring and ease it out of the vagina.
- Wash the pessary with warm water and mild soap (silicone pessaries can be reused; PVC rings are single-use).
- Reinsert the pessary by folding it (or compressing it into a figure-of-eight for silicone folding rings), applying lubricant, and guiding it in with the other hand forming a \"tube\" shape.
- Push the pessary up until the front edge sits behind the pubic bone.
Self-management is most practical with a ring pessary. Some women also learn to self-manage a Gellhorn, though this requires more confidence. Cube and inflatable pessaries require daily removal by design, so self-management is built in.
Medical-grade silicone ring with folding notches for easy insertion and removal. Washable and reusable. Available in sizes 1 (51 mm) to 13 (127 mm).
What does the evidence say? The TOPSY trial
The TOPSY trial (Treatment of Prolapse with Self-care PessarY), published in 2024, was the first large randomised controlled trial comparing pessary self-management with standard clinic-based care. It was conducted across 21 NHS clinics in the UK with 340 women.
Key findings from the TOPSY trial (18-month follow-up)
- Quality of life: Similar in both groups, measured using a pelvic floor-specific questionnaire.
- Complications: 17% in the self-management group vs 22% in the clinic group.
- Serious adverse events: None related to pessary use in either group.
- Cost: Average healthcare costs were £578 per self-managed woman vs £728 per clinic-managed woman, a saving of £150 per patient.
- Satisfaction: Women valued the control and fewer clinic trips. Both women and clinicians found self-management acceptable.
About 20% of women in the self-management group switched to clinic care by 18 months, usually because they found insertion or removal difficult. The researchers noted that the benefits of self-management may therefore be understated. Results were consistent regardless of age, hysterectomy history, or hormone therapy use.
Following the TOPSY trial, the Pelvic, Obstetric and Gynaecological Physiotherapy group (POGP) recommends that self-management should be routinely offered to women who are physically and mentally able to do it.
How do you care for a pessary?
Clinic-managed pessaries: If your pessary is changed at clinic appointments, you do not need to remove it at home. Attend your scheduled appointments (usually every six months) for the pessary to be changed and your vaginal health checked. If you notice any problems between appointments, contact your clinic.
Self-managed ring pessaries: How often you remove and clean a reusable silicone pessary is a decision to make with your clinician. Some women remove, wash, and reinsert weekly; others do so less often. Use warm water and mild, unscented soap. Rinse thoroughly and apply water-based lubricant before reinsertion.
Cube and inflatable pessaries: These must be removed every night. Wash with warm soapy water, rinse, and allow to dry before reinserting the next morning. Do not leave a cube or inflatable pessary in place for more than 24 hours.
Vaginal oestrogen: Many clinicians recommend topical vaginal oestrogen (as a cream, tablet, or pessary) two to three times a week to keep the vaginal tissues healthy. This reduces dryness, discomfort, discharge, and the risk of erosion or ulceration. NHS guidance states that topical vaginal oestrogen is minimally absorbed and does not increase the risk of breast cancer or blood clots. If oestrogen is not suitable for you, a vaginal moisturiser is an alternative.
What problems can a pessary cause?
Most women use a pessary without significant problems. When issues do occur, they are usually mild and treatable.
| Problem | What it means | What to do |
|---|---|---|
| Increased discharge or odour | May indicate a vaginal infection | See your GP or clinic. A swab may be taken and antibiotics prescribed. |
| Vaginal bleeding | May be caused by erosion or ulceration of the vaginal wall | Contact your clinic. The pessary may be removed for a few weeks while the tissue heals, with nightly vaginal oestrogen. |
| Pessary falling out | Usually means the pessary is too small | Return to clinic for a larger size or different type. |
| Discomfort or pressure | May mean the pessary is too large or incorrectly positioned | Return to clinic for resizing. Brief discomfort immediately after a change is normal. |
| Difficulty passing urine or opening bowels | The pessary may be pressing on the urethra or rectum | Contact your clinic promptly. If you cannot pass urine at all, seek urgent medical attention. |
| Ulceration or erosion | The pessary has rubbed against the vaginal wall, causing a sore area | The pessary is removed for 2 to 4 weeks with vaginal oestrogen to allow healing. This is more common with long-term use and is why regular check-ups are important. |
Leaving a pessary in for too long without review increases the risk of erosion, infection, and in rare cases, the pessary becoming embedded in the vaginal wall. This is why regular clinic follow-up (or consistent self-management with a care routine) is essential.
PVC vs silicone pessaries: what is the difference?
The two main materials used in ring pessaries each have distinct advantages.
| Feature | PVC ring (e.g. Portia) | Silicone ring (e.g. Milex) |
|---|---|---|
| Reusable | No (single-use, replaced at each visit) | Yes (washable, reusable for months) |
| Flexibility | Flexible, 12.5 mm cross-section | More pliable; folding versions collapse at notches |
| Self-management | Possible but less common (a new ring is needed each time) | Ideal (the same ring is reinserted after cleaning) |
| MRI compatible | Yes | Check with manufacturer (some contain a steel spring core) |
| Latex free | Yes | Yes |
| Cost per unit | From £2.89 | From £77.99 |
| Size range | 50 to 110 mm (3 mm increments) | 51 to 127 mm (numbered sizes) |
| Typical use | NHS clinic-managed care | Self-management or clinic care |
PVC ring pessaries are the UK standard for clinic-managed care because of their low cost and the fact that they are replaced at each visit. Silicone ring pessaries are better suited to women who self-manage, as the same device can be removed, cleaned, and reinserted many times.
Medical-grade silicone Gellhorn with suction-based support. Available in standard and short-stem versions, 38 mm to 95 mm.
Frequently asked questions
How long can you leave a pessary in?
A ring pessary managed by a clinic is typically changed every six months. Self-managed silicone ring pessaries can be removed and cleaned at intervals agreed with your clinician, often weekly or fortnightly. Cube and inflatable pessaries must be removed every night. Leaving any pessary in for longer than recommended increases the risk of erosion and infection.
Does a pessary hurt?
A correctly fitted pessary should not be painful. You may feel mild pressure or awareness for the first day or two after fitting, but most women cannot feel the pessary during normal activities. If you experience persistent discomfort, contact your clinic for a size adjustment.
Can you have sex with a pessary in?
Ring pessaries are generally compatible with sexual intercourse, though your partner may be able to feel the device. Gellhorn, shelf, donut, cube, and inflatable pessaries should be removed before penetrative intercourse. If being sexually active is important to you, discuss this with your clinician, as it will influence the type of pessary chosen.
Can a pessary fall out?
Yes, especially during straining, heavy lifting, or if the pessary is too small. If your pessary falls out repeatedly, you need a larger size or a different type. Some women find the pessary loosens over time as the pelvic floor muscles change, requiring an adjustment at their next appointment.
Do you need a prescription for a pessary?
Pessaries are classified as medical devices, not prescription medicines. However, they should only be used under the guidance of a trained clinician who has assessed your prolapse and fitted the device. Buying a pessary without professional fitting is not recommended, as the wrong size or type could cause harm.
Can pelvic floor exercises replace a pessary?
Pelvic floor exercises (Kegel exercises) can improve symptoms of mild prolapse and may reduce the need for a pessary in some women. NICE recommends supervised pelvic floor muscle training as a first-line treatment. However, for moderate to severe prolapse, a pessary provides mechanical support that exercises alone cannot. Many women use both approaches together.
How much does a pessary cost on the NHS?
Pessary fitting and clinic-managed care are free on the NHS. The pessary itself, the fitting appointment, and follow-up visits are all covered. If you choose to buy a silicone pessary privately for self-management, the cost ranges from around £70 to £85 depending on the brand and size.
Can you use a pessary during pregnancy?
Pessaries are sometimes used during pregnancy, particularly for cervical insufficiency (a cervical cerclage pessary, which is different from a prolapse pessary). A prolapse pessary is not typically used during pregnancy. If you have prolapse symptoms during pregnancy, speak to your midwife or obstetrician.
What happens if a pessary gets stuck?
If you cannot remove a pessary yourself, do not force it. Try relaxing in a warm bath, applying water-based lubricant, and bearing down gently. If it still will not come out, contact your GP or clinic. In very rare cases where a pessary has been left in for a long time, removal under sedation or general anaesthesia may be needed.
Are there alternatives to a pessary?
The main alternatives are pelvic floor muscle training (for mild prolapse), lifestyle changes (weight management, avoiding heavy lifting, treating chronic cough), and surgery. Surgical options include vaginal repair, sacrocolpopexy, and mesh procedures, though mesh has been restricted in the UK. Your gynaecologist can explain which options are appropriate for your situation.
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Browse Gynaecology Supplies →Related reading: Speculum Types and Sizes: A Complete Guide for Healthcare Professionals
Medical disclaimer: This article is for informational purposes only and does not constitute medical advice. Pessaries should only be fitted and managed under the guidance of a qualified healthcare professional. If you are experiencing symptoms of pelvic organ prolapse, consult your GP or gynaecologist. Content reviewed October 2026.
