What happens during a pessary fitting appointment?

If you have never had a pessary before we will start the appointment with a conversation about you and what your goals are in order to figure out the type of pessary to best fit your needs. Education about types of pessaries, indications for use, possible side effects or risks versus benefits, and more general information will also be covered. At that point, if you decide that you would like to proceed with a pessary fitting then we will start the process.

Finding the style and size of pessary that works best for you sometimes involves a bit of trial and error. It’s kind of like trying on new shoes. In one style you might be size 9, in another you might be size 8, you might find one style more comfortable, and so on.

We begin with an internal exam. This is for me to be able to understand where your prolapse is sitting and ensure that the tissue within the vaginal canal is healthy. (If you have a lot of pain with an internal exam then inserting and removing the pessary might be tough or it might change the type of pessary we decide to try first).

Then we begin trying pessaries! I will insert a pessary and ask “can you feel it?” (hopefully the answer is no). Next I’ll get you to stand up and move around, maybe trying some movements that would normally be bothersome or cause you to leak (such as coughing, jumping, or bending over). I might also ask you to go for a short walk or run or ask you to go pee. We do this to ensure the pessary is comfortable and meeting expectations. If you leak or feel heaviness while testing the pessary we remove that pessary and try a different one. We repeat that process until we find the right pessary for you. This may happen in the first appointment or it may require a second appointment. Pessary fitting appointments are 1 hour long.

Once we have found the correct pessary you will be taught how to insert and remove the pessary yourself and we go over pessary care instructions.

Will I leave with a pessary the same day?

Our clinic tries to keep some of the most common pessary shapes and sizes in stock. If we have the correct pessary in the clinic that day we would be happy to sell it to you and you can leave with a pessary the same day as your appointment. If we do not have your size, we will direct you to a local pharmacy or website to purchase your pessary.

How much does a pessary cost?

 Pessaries generally cost around $90-100.

Do I have to take the pessary out to go to the bathroom?

No. A pessary should not interfere with bowel or bladder emptying.

Do I have to take the pessary out for intercourse?

Yes. Most people find it most comfortable to remove the pessary before intercourse.

How long does a pessary stay in?

The answer is “it depends.” Some people insert their pessary every morning and take it out every night. Some people wear theirs for several days in a row. Some wear the pessary only while they are participating in activities which would normally cause them to be uncomfortable.

Some people are unable to insert or remove the pessary themselves. In this case the pessary is inserted by a healthcare professional and then removed, cleaned and reinserted by the health professional every 3 months.

The type of pessary you have, along with personal preference may also influence how often you remove it.

How often are follow ups?

Ongoing fit checks and follow ups are important to ensure the health of the tissue within the vaginal canal and confirm the pessary is functioning well.

Below is a typical follow up schedule for someone who takes out and cleans their pessary on a regular basis. Once you have been fit with your pessary and we have confirmed that it is working well for you we will determine a follow up schedule to fit your needs.

• 1st follow up: 2 weeks after receiving the pessary

• 2nd follow up: 3 months later

• 3rd follow up: 3 months later

• 4th follow up: 6 months later

• 5th follow up: to be determined