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A qualified health care professional with experience in managing pessaries

 You should be offered a chaperone and you may also choose to have someone else with you such as a partner or friend.

Not all pessaries work for all women and all types of prolapse. After you have been assessed, the person who is fitting your pessary should show you which device is most likely to be appropriate for you. They will discuss your options with you, which may include the option of managing the pessary yourself. They will then show you the device, explain how it works and fit your pessary with your consent.

N.B. Sometimes it can take more than one fitting to find the device and size that works best for you. Throughout the process your nurse practitioner, will work with you to make sure that you get the best possible results.

The person fitting your pessary will have assessed which size pessary is required and will show the pessary to you before it is fitted. Ask to see what it looks like.

Pessaries are usually made of plastic or silicone.

No, ideally you should not feel it once it is in place and have a good fit. However, the pessary can move within the vagina, a bit like a tampon, so you may be aware of it at times, but it should not be uncomfortable. The person fitting your pessary will be able to show you what to do If it does become uncomfortable.

A pessary should not fall out if correctly fitted. There is an element of trial and error when fitting pessaries for the first time, so a pessary could fall out while you are trying different ones. Once you have a well-fitting and comfortable pessary, it will not come out during exercise, but it can still move.

No. You should be able to continue exercise with a pessary. Many women find they can be more active once they have a correctly fitted device in place.

Yes. It is important to continue with your pelvic floor exercises.

Yes. You can use a tampon if you have a ring type pessary as long as it feels comfortable.

Supporting the area between the anus and the vagina when opening your bowels gives confidence to push, without pushing the pessary out. Wrap toilet paper or a sanitary pad around your hand and press and support the area just in front of the anus and around the opening of the vagina. Avoid getting constipated.

Depending on which type of pessary you have, this can be every 1–6 months by a healthcare professional. For self-managing pessaries, how often you remove a pessary depends on the type of pessary you were given and personal choice, but it is still important to check your pessary regularly. For pessaries that don’t require removing daily, they can be removed occasionally, for example once a week or a month, though you do not have to do this if you don't want to. As a guide the minimal time for changing a pessary and replacing it with a new one is once every 6 months.

You may occasionally get a vaginal infection which can be treated with a local antibiotic vaginal cream or by removing the pessary and leaving it out for a while. Oral antibiotic tablets will be given if required.

An infection is less likely if the pessary is changed regularly and the vaginal tissues are kept healthy by using vaginal oestrogen which may be prescribed.

It is possible to have penetrative vaginal sex with some pessaries such as a ring or Shaatz pessary, but others would have to be removed first and replaced later. You will be able to discuss with your healthcare professional options of which pessary might best suit you, along with any concerns you may also have about contraception.

Some pessaries can be self-managed. The clinician who fitted your device will assess suitability and discuss this with you and will teach you how to remove it and reinsert it while you are with them in clinic. It is not usually difficult to remove a pessary or replace one once you have been shown how and have practiced.

Yes. You may be offered self-management of your pessary by your healthcare professional if suitable. You can manage your pessary yourself once you have been shown how to, have practiced and are confident to do so.

You may find it more comfortable to use a vaginal lubricant when inserting a pessary, especially a new one, but you do not have to.

Vaginal or topical oestrogen is a very low dose of the hormone oestrogen.

Vaginal oestrogen can be used either as a cream or in the form of a pellet (also called a pessary) which is inserted into the vagina and absorbed by the vaginal tissue. This is also available as a ring-shaped device which releases hormone slowly over 3 months. This means that unlike other hormone replacement therapy (HRT) the amount absorbed into the blood stream and therefore traveling round the body (systemic absorption) is very small.

Oestrogen is found naturally in the body and one of its functions is to keep the condition of the vaginal tissues healthy. Oestrogen can be lacking during and after the menopause and it can cause vaginal atrophy. Vaginal atrophy is when the lining of the vagina becomes thin and dry and the skin around or in the vagina can feel sore or itchy. Your healthcare professional will advise you if you need oestrogen and which type will be most suitable for you

Oestrogen cream can be very effective at making the condition of the vagina healthier and reducing soreness and discomfort and in turn, reducing the risks of infection and ulcers which a vaginal pessary may cause.

No. Using a vaginal pessary controls the symptoms of a prolapse by supporting it. The pessary will not ‘heal’ or ‘cure’ the prolapse. Sometimes when the pessary is removed, there may be a temporary improvement, but this is not likely to last over time.

It is one of a small number of choices available for managing vaginal prolapse, but each woman is different and treatment choice varies with each individual. You can change your mind about your treatment at any time.

Surgery may be considered but often women are offered a less invasive option to try first as all surgery will carry some risk including prolapse recurrence. Surgery for prolapse may include hysterectomy if the uterus has prolapsed. However, with some surgical procedures women do not need to have a hysterectomy. Removing the uterus itself does not always cure the prolapse and may make other types of prolapses more common.

It is possible to buy online but it is not advisable without having been assessed by a trained professional who can make sure you have the correct and most suitable pessary. There are a large variety of pessaries on the market and an appropriately trained healthcare professional will be able to help you find one that is likely to help you and your specific prolapse and symptoms. If you buy one online, it would be advisable to ask a healthcare professional to check it is suitable for you before you use it.

Don’t panic! It is much easier to remove a pessary if you are relaxed and in the right frame of mind.

Contact the clinic where the pessary was fitted, your GP or go to the nearest A&E.