The Pessary Boutique is open to the community as part of Mountains Meet Medical for pessary fitting and physician-guided maintenance care. Dr. Marshall offers this medical service as a non-surgical option that for appropriate candidates can greatly help manage symptomatic pelvic organ prolapse (POP) and incontinence.
This is an Out-of-Network, Self-Pay Clinic
At this time, we are unable to provide service for Medicare eligible or enrolled patients.
We are an out-of-network, self-pay clinic and do not submit for insurance reimbursements. If not insured under TRICARE we can provide a superbill for you to submit to your insurance carrier for potential reimbursement. If you are interested in doing this, please first check with your insurance carrier to discuss the best possibility for reimbursement.
What is a Vaginal Pessary?
A vaginal pessary is a removable medical device designed to be placed in the vagina to support pelvic structures and treat symptoms and complications of existing pelvic organ prolapse (POP). POP is the such as of the bladder and related structures (cystocele), rectum (rectocele), or uterine prolapse) and especially stress urinary incontinence.
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Examples of manifestations of POP include but are not limited to a sense of pelvic bulging, protrusion, heaviness, discomfort, or pressure. In some cases, a pessary may provide relief from fecal incontinence or difficulty with emptying.
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Pessaries are not definitively curative but when appropriate are an excellent non-surgical therapeutic option.
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Pessaries are available in various sizes, shapes (such as ring, dish, cube, donut, and dish with central stem), and are commonly made of medical-grade silicone.
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A properly fitted pessary should sit comfortably and safely provide internal support, minimizing pressure and improving quality of life.
Who Can Benefit from a Pessary?
The pessary is a well-established and conservative treatment option for long term use, temporarily, intermittently during specific activities, or until conditions contributing to symptoms resolve. A pessary can enhance or aid recovery during the course of pelvic floor PT. Pessaries are often recommended for symptomatic individuals who:
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Prefer to avoid or delay surgery
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Are awaiting surgical intervention
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Are post-surgical
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Need symptom relief or preventive support during physical activities
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Are working on improving pelvic floor strength
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Are cleared for use during pregnancy
Importance of the Process
Pessaries should be fitted by a licensed healthcare provider who is experienced with internal pelvic exams for determining if using a pessary is the right therapeutic choice and for selecting the best fit. This evaluation process often does require trial and adjustments.
Upon a successful fitting, periodic pelvic exams and individual reassessments are essential, especially for checking on tissue health and pessary effectiveness. Periodic maintenance follow ups help avoid improper use, discomfort, or serious complications such as inflammation, infection, urinary or fecal retention, injury, and dangerous tissue erosion.
What is the process of our Pessary Fitting and Maintenance?
Step 1
Initial Assessment and Consultation
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Perform an initial screening for whether you are a medically appropriate candidate for pessary trial and fitting
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Candidacy does not guarantee that a fitting will be successful. We may find with a fitting trial that a pessary is not the right therapeutic tool for you, or that you will benefit from other interventions prior to use of a pessary.
Step 2
Pessary Fitting Visit
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Conduct a pelvic examination to assess whether a pessary may be medically appropriate for you
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Select a trial pessary based on anatomical needs, medical history, lifestyle preferences, comfort, and most effective fit
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Provide education on self-insertion, removal, and cleaning techniques
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Determine a follow-up and maintenance schedule specific to your individual needs
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Patients purchase their personal pessaries according to the fit identified, either with the assistance of our clinic, or through an outside vendor.
Step 3
Fitting Trial Period
Follow-ups
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A successful fitting Trial Period requires at least two follow-up appointments with a selected pessary to ensure comfort, efficacy without functional complications, and tissue health. The first follow up occurs at 1-2 weeks and then 3 months after initial fitting. A 4-6 week follow-up between the two appointments may be considered for additional troubleshooting.
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It is not unusual for an initial experience of very mild discomfort, vaginal discharge, or irritation in the early trial period; however, these symptoms and signs should quickly resolve or be minimized.
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It is possible that we will reach the conclusion that a pessary is not right for you during the course of the trial period.
Fitting Trial Period
Expectations
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The goal is to obtain the best match for you during the fitting trial. Please consider that you may need to purchase of one or up to several trial pessaries despite best trial efforts. You may find as you go about your activities while using your personal pessary that in-clinic simulation is not the same as performance out in the world; real-world trial of your pessary may lead to information that a refitting and new pessary sizing or type is appropriate for you.
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The body is dynamic and tissue changes will occur over time, leading to the possibility that pessary refittings may be necessary over a period of weeks, months, or years. It may also be possible that with pelvic floor PT a pessary will no longer be needed either constantly, only periodically, or not at all.
Maintenance Follow-ups
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A pessary device must be removed, cleaned, and the vaginal tissue examined at regular periods to minimize complications. Maintenance appointments include pessary removal, tissue health check, device cleaning, and re-insertion.
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For Self-Managing patients maintenance appointments are medically advised every 6 or 12 months for check-up exams depending on the pessary type and individual patient needs. Self-managing patients are able to regularly insert, remove, and clean a pessary on their own in between these follow ups. For consistent wearers, removal may be necessary as frequently as daily to every few months depending on the pessary type.
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For Clinic-based Care patients (aka Medical Management) maintenance appointments are indicated for scheduling at least every 3 months for tissue safety depending on the pessary type and individual needs. Clinic-based Care patients benefit from more frequent follow up for maintenance.
Pelvic Health Osteopathic Manipulative Therapy (OMT)
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If indicated, pelvic health OMT is included at no additional cost as a part of your periodic pessary check-in appointments.
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Dr. Marshall provides OMT assessments and treatments as part of her skillset as an osteopathic physician and are intended as an integrated benefit to optimizing pelvic care, for neuromuscular and myofascial tension, scar tissue mobilization, and more.
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OMT treatments are conducted as medically indicated based on the diagnosis of somatic dysfunctions and medical appropriateness to treat.
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Fore more information about OMT, please see our OMT page.
General Risks and Contraindications of Pessary Use
Potential risks and complications of pessary use include:
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Vaginal discharge or odor or disruption of natural balance of vaginal flora
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Vaginal tissue inflammation, infection, or injury
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Urinary or fecal retention due to physical obstruction
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Significant discomfort or pressure
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Bleeding or ulceration of vaginal tissue
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Development of fistulas or erosion between organs
Pessary use is contraindicated in the presence of:
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Active genital or pelvic infections or outbreaks
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Vaginal sores or ulceration
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Inability or unwillingness to attend to regular maintenance protocol and follow ups
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Allergy or unresolving sensitivity to the device material
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Inability to tolerate pelvic exams and use of the device
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Undiagnosed vaginal bleeding
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Recent pelvic surgery until clearance
Pessary use must be used with caution or may be contraindicated in the presence of:
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Pregnancy; in pregnancy, the patient’s care team should be partnered and guided with regular follow ups, as there is a small but increased risk for potential infection and associated miscarriage.
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Difficulty with following regular maintenance protocol and periodic appointments
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Vaginal stenosis or scarring that prevents safe fitting
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Atrophic vaginitis (use of vaginal estrogen therapy may improve tissue health and treat/prevent irritation or dryness associated with pessary wear, especially in perimenopause or postmenopause)
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Rectovaginal or vesicovaginal fistula (an opening between the vaginal wall and the rectum or bladder)
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Urethral diverticulum (outpouchings along the urethra)
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Pessary-induced bladder or fecal retention due to inability to void
FAQ
Can I receive a refund for any pessary services or pessary purchases?
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Our pessary services and in-clinic purchases are non-refundable.
Will the fittings cause pain and will I need anesthesia?
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Any very mild discomfort during fitting or sense of the pessary sitting in place should resolve; discomfort should not equate pain. A properly fitted pessary should not cause pain and, therefore, there should not be a need for anesthesia. If there is any onset of pain, high sensitivity, or intolerance with the pelvic exam and fitting, the process will be discontinued and next steps discussed. However, this typically means that a patient may not be a current candidate for wearing pessaries; this does not mean that one can then never be a candidate. You should be able to perform normal daily activities comfortably while wearing a pessary; self-insertion and removal should equally not be painful.
Can I have sex with a pessary in place?
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Many pessaries are compatible with sexual activity; otherwise, the pessary can be removed prior. Types that may align with your preferences can be discussed.
Are pessaries a contraceptive device?
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No, a pessary does not prevent pregnancy.
Do pessaries trigger metal detectors or airport security?
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No, pessaries should not trigger metal detectors. Airport body scanners may detect a pessary, however, and we are happy to provide a medical letter for you to carry and present in the unlikely event that you are asked about it.
Medical Disclaimer
The information provided on this website is intended for educational and informational purposes only. It does not substitute receiving direct medical advice, diagnosis, or treatment. Always directly consult with a qualified healthcare professional regarding any medical concerns or conditions. Do not delay or disregard seeking professional medical advice because of information found here.
If you are interested in learning more about our pessary fitting and maintenance services, or if you are experiencing symptoms of pelvic organ prolapse or incontinence, we warmly invite you to schedule an initial assessment and consult with our clinic.