Commonly used pessary types – a practical guide
Pessary selection and sizing is often more of an art than a science. However, there are
several factors that may be considered when selecting a pessary. These include the shape of
the vagina, the severity of the pelvic organ prolapse, whether the patient would like to self-
manage her pessary and if she wishes to commence or maintain sexual activity.
This section will describe each of the pessaries commonly used in the UK, discussing fitting
and removal techniques along with information on materials and sizes for each type. Many
pessaries are available in a variety of materials, some which are flexible and others that are
rigid. Although, it is considered that some women may need a more rigid pessary to support
their prolapse, many consider that a flexible pessary is more comfortable, easier to remove
and insert and therefore easier to self-manage. A silicone pessary being softer may be less
likely to erode the vaginal walls.
Women can be sexually active with some types of pessary in situ or they may choose to
remove the pessary prior to intercourse. This may be more challenging with certain types of
pessary for example the Gellhorn, shelf and Donut pessary.
It is noted that there are regional/local variations in pessary preferences and these may be
due to experience, knowledge, availability and cost. Not all pessary clinicians will use all
types of pessary in their routine practice, but an understanding of what is available and why
it may be used is essential in managing cases where more conventional pessary types have
been unsuccessful.