Products to Use for Successful Pessary Management: Your Essential Guide to Comfort and Care

The choice to use a vaginal pessary for pelvic organ prolapse (POP) or stress incontinence is a fantastic non-surgical path to reclaiming your comfort and confidence. However, proper care is crucial for avoiding complications like irritation, discharge, and odor.

To truly master your pessary management, you need the right support products. This comprehensive guide goes beyond the basics to detail the specific non-prescription and prescription items that can elevate your experience, minimize common side effects, and keep your vaginal tissues healthy.

For the broad context on pelvic changes in menopause, we recommend this article: Your Complete Guide to Menopause, Bladder Health, and Pelvic Floor Wellness.

Optimize Vaginal Health: Moisturizers and Lubricants

The most common side effect of pessary use is an increase in vaginal discharge and, for postmenopausal women, irritation or erosion due to thinner, drier tissues. Using the correct topical product is your #1 defense against these issues.

1. Non-Hormonal Vaginal Moisturizers (For Daily Use)

Vaginal moisturizers are designed to be absorbed by the tissue, helping to restore elasticity and moisture over time, not just temporarily. Regular use can keep the vaginal walls plump and less prone to friction from the pessary.

2. Water-Based Lubricants (For Insertion/Removal & Intercourse)

Lubricants provide temporary slip and are essential for comfortable insertion, removal, and sexual activity with most pessary types (especially the smaller ring-shaped ones).

• For Insertion/Removal: A small amount of a high-quality, water-based lubricant (e.g., K-Y Jelly, Sliquid, Good Clean Love) on the pessary makes the process smooth and pain-free.
• Safety Check: Always choose water-based lubricants when using a silicone pessary, as petroleum-based products (like Vaseline) or some oils can degrade the silicone material.

3. Prescription Local Vaginal Estrogen (For Postmenopausal Women)

If you are postmenopausal, your healthcare provider may prescribe low-dose vaginal estrogen (a form of local hormone therapy).

• Mechanism: It works by thickening and improving the health of the vaginal tissue (maturation of the vaginal epithelium).
• Key Benefit: Studies show that concurrent use of vaginal estrogen significantly reduces the incidence of increased vaginal discharge, bleeding, and erosions (cuts/sores) compared to non-users, leading to higher rates of continued pessary use.
• Available Forms: This may come as a cream (e.g., Estrace®), a tablet/suppository (e.g., Vagifem®), or a slow-releasing ring (e.g., Estring®). This is a local treatment and is not the same as systemic Hormone Replacement Therapy (HRT).

Cleaning and Hygiene Tools

If you are taught to manage your pessary at home, having the right tools for cleaning and hygiene is paramount.

⚠️ Important Cleaning Note: Do NOT use hydrogen peroxide, alcohol, or harsh detergents, as these can damage the silicone and lead to irritation when reinserted. Also, avoid douching or using perfumed vaginal washes, as they disrupt the natural vaginal pH and can worsen discharge or lead to infection.

Troubleshooting and Management Aids

Even with the best routine, issues can arise. Knowing which products can help address common complications will save you a trip to the doctor’s office.

For Odor or Abnormal Discharge (Consult your Provider First!)

While an increase in odorless white discharge is normal, an unusual or foul-smelling odor or discharge could signal an infection (like bacterial vaginosis or yeast).

• Trimo-San Gel: This is an acidic, prescription-available vaginal gel sometimes dispensed by providers for its mild cleansing properties, often used twice weekly. While clinical studies on its direct effect on preventing bacterial vaginosis are mixed, some individuals find it helpful for odor management.
• Prescription Antibiotics/Antifungals: If an infection is confirmed, your provider will prescribe an appropriate vaginal or oral medication.

For Easier Removal (Cube Pessary Users)

The Cube pessary works via suction and requires daily removal for most users.

• Silicone String: The cube pessary comes with a silicone string to help you locate and manipulate the device for removal.
• Finger Sweep Technique: The most effective method is to insert a finger to break the suction before gently easing the pessary out. Using a bit of water-based lubricant on your finger can help facilitate the sweep. Never yank on the string alone.

The Complete Pessary Care Routine

Successfully using a pessary relies on a consistent cleaning and maintenance schedule tailored to your device type and your doctor’s recommendations. Implementing a routine ensures comfort, prevents infection, and maximizes the lifespan of your device.

1. Daily Essentials (For Self-Removable Pessaries)

For devices like the Ring, Gehrung, or Cube pessaries, which you manage yourself:

2. Weekly Deep Cleaning (For Self-Removable Pessaries)

Aim to deep-clean your pessary at least once a week, or more often if you experience heavy discharge or odor.

1. Remove the Pessary: Use your preferred technique.
2. Inspect: Visually check the device for any tears, cracks, or excessive mineral buildup. If damaged, contact your provider for a replacement.
3. Wash: Hold the pessary under warm running water. Apply a small amount of mild, unscented liquid soap. Use your fingers to gently rub and clean all surfaces, ensuring no discharge remains in grooves or holes.
4. Rinse: Rinse the device thoroughly under warm water until all soap residue is gone.
5. Dry: Pat the pessary completely dry with a clean, lint-free cloth or allow it to air dry on a clean surface. Do not reinsert a wet pessary.
6. Rest (Optional): Many users benefit from leaving the pessary out for one night per week to give the vaginal tissue a complete rest. Use this opportunity to apply your preferred vaginal moisturizer or local estrogen.
7. Reinsert: Apply lubricant and reinsert the clean, dry device in the morning.

3. Professional Care Schedule (For Provider-Managed Pessaries)

For space-filling devices (Gellhorn, Donut, some larger rings) that you cannot or are advised not to remove yourself:

• Schedule: You must attend follow-up appointments every 3 to 6 months (as directed by your doctor).
• Procedure: During these visits, your healthcare provider will remove the pessary, clean it thoroughly, examine your vaginal walls for any signs of irritation or erosion, and then reinsert the device.
• Importance: These regular check-ups are essential for preventing severe complications like vaginal erosion or fistula formation.

When to Call Your Healthcare Provider Immediately

While routine care is often simple, certain symptoms require professional attention to prevent complications: