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.
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 therefore treat symptoms and complications of existing pelvic organ prolapse (POP). Pessaries can also potentially support the bladder neck and help incontinence, in particular of the stress urinary type.
POP is a condition in which one or more of the pelvic organs are no longer supported in their normal anatomic position due to weakening of pelvic floor structures, thus bulging into or beyond the vaginal canal. When the front vaginal compartment prolapses this is often related to the bladder (cystocele), the back compartment the rectum (rectocele) or bowel (enterocele), and/or the upper compartment due to the uterine or vaginal vault dropping down out of position (if you have had a hysterectomy).
Pessaries do not permanently cure, fix or repair pelvic organ prolapse or stress incontinence. A pessary that works well will immediately resolve or significantly reduce the sense of prolapse heaviness and/or bladder leaking symptoms. If it fits well, you will be unable to feel the pessary at all once in place, or you may experience a minimal supportive sensation. There should not be any significant sense of pressure due to the pessary. A pessary should not cause pain once it is inserted into place. For most pessaries you can insert and remove the pessary yourself, giving you the flexibility to choose when you use it.
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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 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, intermittently during specific activities, or temporarily 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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Have any grade or type of pelvic organ prolapse with the presence of bothersome symptoms: heaviness, pressure, bulging, difficulty voiding the bladder/fully emptying, mental/emotional bother
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Have stress urinary incontinence
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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
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Prefer to avoid or delay surgery
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Are awaiting surgical intervention
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Are not surgical candidates (examples: due to comorbidities, age)
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For those considering surgery but who are not yet done childbearing
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To rule out occult incontinence prior to pelvic surgery
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Are post-surgical
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, as well as monitoring and identifying medical issues that could interfere with safe pessary use. 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.
Examples of Pessary Types
These Direct Care Services are Out-of-Network, by Self-Pay Only.
We are insurance-free and so do not directly participate with, nor bill insurance for in-house services.
Medicare Eligible or Enrolled Patients
At this time, we are unable to provide service for Medicare eligible or enrolled patients, even if self-pay. This is due to federal regulations related to requirements for out-of-network physicians. We are working on changing this availability.
If you are not enrolled in a government-sponsored health coverage program:
If not insured under Medicare, Medicaid or TRICARE or similar government-sponsored health coverage program, we should be able to provide a superbill for you to submit to your insurance carrier for potential reimbursement. We cannot guarantee reimbursement. If you are interested in submitting services and purchases for insurance reimbursement or utilizing your existing HSA/FSA account to pay, please first check with your insurance carrier to discuss the best option.
Please see our FAQ information page now for information on current eligibility for our services.
Process of our Pessary Fitting and Maintenance
Step 1
Initial Assessment and Consultation
Involves a detailed Questionnaire and a Virtual Visit to
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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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If successful, 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 or follow up periods.
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 1-3 months for tissue safety depending on the pessary type and individual needs.
Pelvic Health Osteopathic Manipulative Treatment (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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OMT sessions outside of the regular maintenance follow-up regimen are at additional cost. For 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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Discomfort or pressure during fittings, trial, or routine removal/insertion or wear of the pessary
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Increased vaginal discharge/secretions, odor, or disruption of natural balance of vaginal flora
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Vaginal or urinary tract irritation or inflammation, infection, ulcers, or injury
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Vaginal tissue bleeding
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New or unmasked stress urinary incontinence
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Difficulty or discomfort with evacuating the bowels or emptying the bladder
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Expulsion of the pessary with bearing down or other activities (examples: running, heavy lifting or straining for a bowel movement)
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Incarceration, Migration (movement of the pessary into the vaginal wall or neighboring tissues), or fistula or erosion development
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Increased risk of squamous cell vaginal cancer (demonstrated in one small study with prolonged use and lack of follow up supervision)
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 periodic 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 cause of vaginal bleeding
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Recent pelvic surgery without pessary use clearance
Pessary use must be used with caution or may be contraindicated in the presence of:
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Uncontrolled diabetes
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Ano-perineal lesions associated with Crohn’s Disease
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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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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
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Cancer, potentially including but not limited to of the vagina, vulva, uterus, or bladder
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Neurological bladder problems
FAQ
Can I receive a refund for any pessary services or pessary purchases?
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Pessary Services & Purchase Policy:
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All pessary-related services and in-clinic product purchases are final and non-refundable. To support pricing that is financially mindful of the stepwise approach to pessary care, we charge separately for each stage of the fitting and evaluation. This allows us to evaluate your needs progressively and if it becomes clear that a pessary isn’t the right solution for you, you only pay for the services up through the stage of visit you have received.
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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. You may need to purchase more than one pessary over time. This tends to occur within the first 1-6 months of using a pessary. Please consider that you may need to purchase one or up to several trial pessaries despite best trial efforts.
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Because of the intimate nature of the device, we are not able to return/refund a pessary after purchases, even if it doesn’t work for you over time. We do our best to avoid this by conducting as thorough of fitting appointments as we are able.
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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. Other therapy as preparation for a pessary may enable a pessary trial in the future. 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.
Why might I need to use vaginal estrogen instead of a lubricant or moisturizer if I’m already on a hormonal pill or patch?
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A very low dose of estrogen applied directly in the vagina (usually as a cream or dissolving tablet) may be prescribed to you in addition to your over-the-counter water-based lubricant/moisturizer depending on your needs. The vaginal dose works locally to improve the health of the tissue and prevent irritation that can be caused by a pessary.
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It is safe for most—even those who cannot take systemic estrogen—but always check with your prescribing physician about this and about any unexpected/abnormal vaginal bleeding or any postmenopausal vaginal bleeding.
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 invite you to schedule an initial assessment and consult with our clinic.