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Pessary fitting must be completed by an appropriately trained health care professional (specially trained doctors, nurses or physiotherapists). The health care professional will do an internal exam to get an idea of size of pessary to start with. The shape of the pessary will be chosen based on your anatomy, symptoms, and grade/type of prolapse. Other factors that will also be considered in determining the most suitable pessary include if you are of menstruating age versus post-menopausal, if you are sexually active, and if you will be inserting/removing the pessary yourself or if you will be seeing a doctor/nurse every few months to have it removed, cleaned, and re-inserted for you.

Even with the additional training required to fit pessaries, the act of pessary fitting is trial and error. It is not uncommon to trial at least a few different sizes or shapes in clinic before finding the best fit. Furthermore, it is not unheard of to need a few different pessaries throughout your life. Sometimes the vaginal walls accommodate for the pessary after a while and you end up needing a larger size. Sometimes one pessary works great for a few months and then for whatever reason, it stops supporting as it once did, and you are back in the clinic trialing different sizes or shapes. Don’t be discouraged if this happens to you. It doesn’t mean a pessary won’t work for you at all, it just means you may have to do a little more exploring.

When I am fitting a client for a pessary, I make sure the pessary is large enough to support the pelvic organs, but not so large that it is putting undue pressure on the vaginal tissues, which can lead to increased chance of risks of pessary use (read about risks of pessary use here: . Check out our blog on characteristics of a well versus ill-fitting pessary . I also ask the client to void her bladder to ensure the pessary is not placing too much pressure on the urethra. Therefore, it is imperative that you see a professional to be fitted for a pessary; do not buy a pessary online as they are not one size fits all and must be fitted for your body specifically.

To recap, these factors are considered in determining which pessary is best for you:

• Anatomy
  • Your pelvic anatomy will be taken into account when choosing a pessary size and style in order to find one that stays in place and supports your organs properly
• Whether you have stress urinary incontinence (SUI), pelvic organ prolapse (POP), or a combination of both
  • Most pessaries are for POP but there are some specifically designed for SUI only and others that are designed for both POP and SUI
• What kind of POP you have
  • Cystocele- bladder prolapse
  • Hysterocele- uterine prolapse
  • Rectocele- bowel prolapse
  • Vaginal vault- top of vagina prolapse (after hysterectomy)
  • Urethrocele- urethral prolapse (not typically treated with a pessary)
  • Urethrocystocele- bladder and urethra (these two are often found together)
  • Enterocele- small bowel prolapse (not treated with a pessary)
• What grade your prolapse is
  • POP is graded out of 4, with 1 being the least severe and 4 being the most. Certain pessaries support mild prolapses best, while others are better suited for moderate prolapses. Of course, this is just a guide and clinical judgment must be employed as each woman presents with an individual collection of symptoms, goals, medical history, etc.
• Sexually active? If you are sexually active, a pessary that can be left in during intercourse will likely be trialed first, so you don’t have the nuisance of having to remove it before spontaneous sexy time!
  • Pessaries that can be left in during intercourse
    • Ring with or without support
  • Pessaries that have to be removed for intercourse
    • Ring with knob
    • Cube
    • Cup/Dish
    • Gellhorn
    • Donut
• If you are still menstruating
  • Certain pessaries provide some amount of drainage, so these can be worn during your period; others, however, must be removed during your period. If you are of menstruating age, this will be considered so that you are given a pessary that is easier to manage and remove yourself.
• If your pessary use will be independently or medically managed
  • Independently managed
    • Some women only wear their pessary during the day or for specific activities; these women must be able to remove and insert their pessary on their own.
  • Medically managed
    • Other women leave their pessary in for months and present to the doctor’s office every few months to have the pessary removed, cleaned, and re-inserted. It is preferred if a woman can independently manage her pessary, but this medical management option is necessary in certain situations. For example, some pessaries are hard to manipulate and if a woman has arthritis in her hands, she may be unable to manipulate the pessary sufficiently to insert and remove it. Other women have mental or physical health concerns that make it more appropriate for an overseeing health care professional to tend to the removal and cleaning.

Although pessary fitting is trial and error, as it is based on the unique combination of each woman’s anatomy, symptoms, type of POP, degree of POP, presence of SUI, stage of life, medical history, and goals, the chart below can be used as a guideline for a place to start when trialing pessaries.

If you are interested in booking an appointment for a pessary assessment and fitting, give us a call today. We would be thrilled to explore the possible options with you!

The information in this blog is provided as an information resource only and should not be used as a substitute for seeking personalized direction from your overseeing physician. Please consult your healthcare team before making any decisions about your pessary treatment plan, which is unique to you and your overall health. Toronto Pessary Clinic expressly disclaims responsibility, and shall have no liability, for any damages, loss, injury, or liability whatsoever suffered as a result of your reliance on the information contained in this blog.