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 Pessary?
A pessary is a removable medical device designed to be placed in the vagina to support pelvic structures. It is commonly used to manage symptoms of existing pelvic organ prolapse and can also help with some types of incontinence. Pessaries are available in various shapes and sizes. They are commonly made of medical-grade silicone. In many cases a pessary can be self-inserted and removed, providing flexibility to choose when used.
What is POP?
POP (pelvic organ prolapse) is a condition in which one or more of the pelvic organs are no longer supported in normal anatomic position due to weakening of pelvic floor structures, thus bulging down into the vaginal canal. When the front vaginal compartment prolapses this is often related to the bladder (cystocele), the back compartment (rectocele or enterocele), and/or the deeper compartment due to the uterine or vaginal vault dropping down out of position.
POP symptoms may include a sense of heaviness, pressure, discomfort, pelvic bulging or protrusion, or difficulty with voiding or incontinence. POP may also in contrast mask pelvic dysfunctions that lead to incontinence.
Who Can Benefit from a Pessary?
The pessary is a well-established conservative treatment option for long term use, intermittently during specific activities, or temporarily until conditions contributing to symptoms resolve. Pessaries are not curative but when appropriate are an excellent non-surgical therapeutic option and can immediately resolve or significantly reduce the sense of prolapse heaviness and/or leaking symptoms. A properly fitted pessary should sit comfortably to safely provide internal support and personal relief, improving quality of life.
Pessaries are often recommended for symptomatic individuals who:
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Experience regularly distressing or bothersome symptoms of POP or during specific activities
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Are cleared for use during pregnancy or during postpartum recovery
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Are working on improving pelvic floor strength through physical therapy
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Prefer a non-surgical option for symptom management or need to delay surgery or are not a surgical candidate
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Are awaiting surgical intervention
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Need to rule out occult incontinence prior to pelvic surgery
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Are post-surgical
Importance of the Process and What to Expect.
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 and fitting process often requires 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 Common Pessary Types
Our Services are by Self-Pay Only.
We are out-of-network from insurance plans and so we do not directly participate with, nor bill insurance. We are a small direct primary care private practice (DPC), which follows a self-pay membership model for care. You can use insurance for what is covered for external services but not for care directly from the clinic.
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 can provide a superbill upon request for you to submit to your insurance carrier for potential reimbursement for standalone Pessary Care as a non-member. We cannot guarantee reimbursement. If you are interested in submitting Pessary services for insurance reimbursement or utilizing your existing HSA/FSA account to pay, please first check with your insurance carrier to discuss the best option.
Process of our Pessary Fitting and Maintenance
Step 1
Initial Assessment and Consultation
Involves a detailed Screening Questionnaire and a Virtual Visit to
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Have a conversation about symptoms and goals
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Discuss whether you are a good candidate for pessary trial
Candidacy does not guarantee that a fitting will be successful. We may find 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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A pelvic exam at your pace and comfort
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Goal to choose a trial pessary based on anatomy, medical history, lifestyle preferences, comfort, and best fit
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If fitting is successful, review techniques on self-insertion, removal, and cleaning
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Determine a follow-up and maintenance schedule specific to your individual needs
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Purchase of a personal pessary according to the fit identified, either with our assistance, or through an outside vendor.
Step 3
Fitting Trial Period
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A fitting Trial Period requires at least two follow-up appointments (at 1-2 weeks and 3 months) with a selected pessary to ensure comfort, efficacy, and tissue health.
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Additional follow-ups may be necessary for troubleshooting.
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Mild sensation/awareness of the pessary, vaginal discharge, or irritation early in the trial period is not unusual but should resolve.
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It is possible that the Trial or Follow Up Periods will demonstrate a pessary is not right for you.
Fitting Trial Period
Expectations
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During the Trial Period the goal is to determine the best fit.
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You may need to purchase up to several trial pessaries in this effort. During real-world trial of your personal pessary we may learn that a adjustment of pessary type or size is needed.
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The body is also dynamic and tissue changes will occur over time, leading to possibly necessary refittings over a period of weeks, months, or years.
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With pelvic floor PT or other interventions a pessary may no longer be as frequently needed or at all.
Maintenance Follow-ups
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Pessaries must be periodically removed and cleaned, and vaginal tissue checked to help avoid complications.
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Maintenance appointments include pessary removal, tissue health check, device cleaning, and re-insertion.
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For Self-Managing patients these appointments are advised every 6 or 12 months depending on the pessary type and individual patient needs. Self-managing patients are otherwise able to regularly insert, remove, and clean a pessary on their own in between these follow ups. 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 every 1-3 months for tissue safety depending on pessary type and individual needs.
Pelvic Health OMT
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If indicated, pelvic health osteopathic manipulative treatment (OMT) is included as a part of periodic pessary maintenance appointments.
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Dr. Marshall provides OMT assessments and treatments as part of her skillset as an osteopathic physician and are an integrated benefit for neuromuscular and myofascial tension, scar tissue mobilization, and more.
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OMT treatments are conducted for diagnosed somatic dysfunctions and based upon 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/wearing 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 while bearing down or during activities (examples: running, heavy lifting or straining)
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Incarceration, migration (movement of the pessary into the vaginal wall or neighboring tissues), 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, trauma, or childbirth 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 improves tissue health and treats/prevents 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 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, a stepwise approach to pessary care is used; each stage of the fitting and evaluation is charged separately. This allows for progressive evaluation of your needs 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 care 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 during the trial period and over time.
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Because of the nature of the device, we are not able to return/refund a pessary after purchase, 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 systemic hormone therapy?
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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, we invite you to schedule an initial assessment and consult with our clinic.