Pelvic & vaginal health

Pessary Fitting: What Happens at the Appointment

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A pessary fitting is a short pelvic exam plus trial sizing of a silicone support device, usually done in one 20-to-30-minute visit. A clinician tries one or two sizes, checks comfort while you stand and cough, and schedules a recheck within 1 to 2 weeks.

Last updated: July 2026

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What is a pessary and why is one fitted?

A pessary is a flexible silicone device placed in the vagina to support the pelvic organs when the tissues that normally hold them weaken. According to the American College of Obstetricians and Gynecologists, a pessary is a first-line, non-surgical option for prolapse and can also ease some urinary incontinence 1. About 3 in 100 women report bothersome prolapse symptoms such as a vaginal bulge or pelvic pressure, and up to 4 in 10 show some prolapse on a routine pelvic exam 1. Prolapse becomes more common after vaginal childbirth and again around menopause, when falling estrogen thins the vaginal walls 2. A pessary addresses that bulge and pressure without an operation, which appeals to women who want to delay or avoid surgery.

What happens during the pessary fitting itself?

The appointment usually begins with a conversation about your symptoms and a standard pelvic exam to gauge the type and degree of prolapse. A clinician then estimates a starting size and gently inserts a trial pessary, most often a ring or a Gellhorn shape 1. Once it is in place, you may be asked to stand, walk, cough, and bear down so the fit can be checked under everyday pressure. Emptying your bladder before leaving confirms the device is not pressing on the urethra. The whole visit typically runs 20 to 30 minutes, and the Office on Women's Health notes that many women are fitted on the first try 2. The process is meant to feel like pressure rather than pain.

How do clinicians find the right pessary size?

Sizing is a trial-and-error process rather than a single measurement, so trying one or two devices in one visit is normal. A good fit means the pessary stays put when you strain but you cannot feel it while sitting or walking 1. If the first size slips or feels tight, the clinician swaps it for another, which is why fittings occasionally take a little longer. Some women also do pelvic floor exercises or work with pelvic floor physical therapy alongside a pessary, and a Cochrane review found pelvic floor muscle training modestly reduces prolapse symptoms 3. Comfort with self-care matters too: many ring pessaries can be removed and reinserted at home, while space-filling types are usually managed in the office.

What happens after the fitting and at follow-up?

A first recheck is usually scheduled within 1 to 2 weeks to confirm the pessary is comfortable and the vaginal tissue looks healthy. Professional guidelines recommend periodic checks, and after the first visit follow-ups often move to every 3 to 6 months, depending on whether you remove the device yourself 1. Between visits, mild spotting, increased discharge, or a change in odor can signal irritation and are worth a call 1. Postmenopausal women are sometimes offered vaginal estrogen to keep the tissue resilient and reduce erosion, which connects to broader care for vaginal dryness after menopause 2. Regular checks matter because a neglected pessary can, rarely, embed in the vaginal wall over months or years.

When a pessary needs a clinician's attention

Certain changes are worth prompt review rather than waiting for the next scheduled visit. A pessary that falls out repeatedly, causes pain, or cannot be removed is a reason to contact your clinician. New vaginal bleeding, foul-smelling discharge, or trouble emptying the bladder or bowel also warrant evaluation, since these can reflect erosion or an ill-fitting device 1. Most women who choose a pessary keep using it comfortably when it is checked on schedule, so many concerns are fixable with a resize or a short break from the device 2. A gynecologist or urogynecologist fits and manages pessaries and can compare them with other options. Gale can help you organize your questions before that visit.

Common questions

For most women a fitting feels like pressure or fullness rather than pain, similar to a routine pelvic exam. Inserting and removing a trial device can feel odd at first, and a good fit should not be painful once it is in place. Telling the clinician about any pinching helps them adjust the size.

Most fittings take about 20 to 30 minutes, including the exam and trying one or two sizes. If the first device does not fit well, swapping sizes can add time. A first follow-up is usually booked within 1 to 2 weeks to confirm comfort.

Usually yes. Once a comfortable size is found and you can walk and empty your bladder with it in place, you typically leave with the device fitted. The clinician explains care, how often to clean or remove it, and when to return.

Gynecologists, urogynecologists, and many trained nurse practitioners and pelvic floor specialists fit pessaries. A urogynecologist has extra training in pelvic floor disorders and may be involved if the fit is complex or if surgery is also on the table.

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When to check in about a pessary

  • —A pessary that repeatedly falls out, causes pain, or cannot be removed is a reason to contact your clinician promptly.
  • —New vaginal bleeding or foul-smelling discharge with a pessary in place is a reason to seek clinician review.
  • —Trouble passing urine or having a bowel movement with the pessary in place warrants prompt evaluation.
  • —New pelvic or lower-back pain, or a sore that does not settle, is a reason to have the pessary checked.

This article is general health education, not medical advice. Whether a pessary suits you, and which type and size fit best, is a decision for a gynecologist, urogynecologist, or trained pelvic floor clinician who can examine you.

References

  1. 1.American College of Obstetricians and Gynecologists (2019). Pelvic Organ Prolapse: ACOG Practice Bulletin, Number 214. Obstetrics & Gynecology. doi:10.1097/AOG.0000000000003519 ✓ACOG guidance that a pessary is a first-line non-surgical option for pelvic organ prolapse, prolapse prevalence figures, fitting and follow-up practice, and warning signs of an ill-fitting device
  2. 2.Office on Women's Health (U.S. HHS) (2025). Pelvic organ prolapse. Office on Women's Health (womenshealth.gov), U.S. HHS. link ✓Patient-facing overview of prolapse risk factors including childbirth and menopause, what a pessary does, and self-care expectations
  3. 3.Hagen S, Stark D (2011). Conservative prevention and management of pelvic organ prolapse in women. Cochrane Database of Systematic Reviews. doi:10.1002/14651858.CD003882.pub4 ✓Cochrane evidence that pelvic floor muscle training modestly reduces prolapse symptoms and can accompany conservative management such as a pessary

3 sources, numbered by first appearance. General health information, not medical advice. AI-assisted editorial content — every citation independently verified. Editorial policy

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