Pessary Quick Answers - 40 Direct-Answer Questions About Silicone Ring Pessaries (2026)
Pessary Quick Answers — 40 Direct-Answer Questions
📋 Table of contents
The basics
A pessary is a small, flexible medical device inserted into the vagina to support pelvic organs affected by prolapse or to reduce stress urinary incontinence. A modern silicone ring pessary is the most common type. FDA Class II medical device (HCPCS A4562), releases no medication. See our complete pessary guide.
Non-surgical management of pelvic organ prolapse (POP) and, with the support variant, stress urinary incontinence (SUI). Mechanically supports the bladder, uterus, or vaginal walls when connective tissue has weakened. Ongoing management — not a permanent repair.
No. Silicone ring pessaries are FDA Class II devices, not prescription drugs. Buy direct from SciMed for $49.99. A prescription is only sometimes required by insurance for reimbursement.
SciMed silicone ring pessaries are $49.99 direct. Through traditional distributors (Milex, Bioteque), patients often pay $80–$400. SciMed purchases are HSA/FSA eligible but are not reimbursed by traditional Medicare (SciMed is not a Medicare-enrolled DME supplier).
SciMed silicone ring pessaries come in sizes 0 through 9, from 44 mm to 102 mm outer diameter. The most-fitted sizes for US patients are 3, 4, and 5. See the size guide.
The without support ring is a simple open ring for prolapse alone. The with support variant has an integrated membrane that compresses the urethra to help with cystocele or SUI. Same $49.99 price for both.
You may benefit if you have symptomatic pelvic organ prolapse (bulge or heaviness), stress urinary incontinence, or want a non-surgical trial before considering surgery. A urogynecologist or OB-GYN confirms with a POP-Q staging exam.
A clinician inserts different sizes to find the one that stays in place without discomfort. If you can't get to a clinic, our Fitting Pack ($129.99) lets you try 3 sizes at home — keep 1, return 2 sealed for $80 refund.
Daily life & activities
Ring pessary without support: usually yes, no removal needed. Ring with support (membrane): typically remove before sex.
Yes. Continuous wear including sleeping is normal. Some patients remove nightly as personal preference, but it's not required.
Yes. Designed to stay in place during running, weight-lifting, yoga. If it consistently falls out during exercise, the size is too small — return for a re-fit.
Yes. Chlorine and salt water do not affect silicone. Rinse after ocean swimming if you notice sand or particles.
Follow your provider's guidance. Common intervals: weekly, monthly, or every 3 months. The 2024 TOPSY RCT supports patient self-management including weekly removal and cleaning.
Rinse with warm water and mild soap. Air dry. No harsh chemicals, alcohol, or abrasive scrubbing. See the complete aftercare guide.
Occasional slipping is normal. Consistent falling-out means the size is too small — return for a larger fit. If it falls out during activity you can't stop, a with-support pessary may hold better. See our troubleshooting guide.
Don't panic. Wait 20–30 minutes to reduce anxiety-related tension. Try squatting and bearing down while hooking a finger under the rim. If it still won't come out, call your provider. See the removal guide.
Safety & side effects
Yes. Decades of clinical safety data. Common side effects (mild discharge, occasional odor) are managed with routine cleaning. Serious complications (erosion, embedded pessary) are rare (~1–3% at 5+ years) and almost always preventable with regular follow-up. See our complete safety guide.
Vaginal discharge (40–60% of patients, mild), mild odor (20–35%, managed with cleaning), mild pressure sensation in the first 2 weeks (15–25%, resolves as tissue accommodates). All manageable.
The pessary itself doesn't cause infection but can shift vaginal flora. About 5–10% of users develop recurrent bacterial vaginosis or yeast, particularly post-menopausal patients. Topical vaginal estrogen dramatically reduces this risk.
Prolonged pressure from a poorly-fit or infrequently-cleaned pessary can erode the vaginal mucosa. Rare (1–3% at 5+ years) and almost always preventable with 6-month follow-up and topical vaginal estrogen for post-menopausal patients.
Within 24 hours for: persistent pelvic pain, unusual bleeding, foul-smelling discharge, fever, inability to urinate 4–6 hours, or new persistent pressure. Immediate ER for severe pain, heavy bleeding, unable to urinate 6+ hours, or high fever with severe abdominal pain.
No. No established link between silicone pessary use and cancer of the cervix, vagina, or reproductive organs. Silicone is chemically inert.
Yes: active vaginal or pelvic infection, unexplained bleeding, open sores, severe vaginal atrophy without topical estrogen, or unwillingness to attend follow-up appointments (biggest predictor of complications).
Yes. A ring pessary and IUD sit in different anatomical planes and do not interact. Millions of patients use both simultaneously.
Cost, insurance, and HSA/FSA
Usually yes. Most commercial insurance covers 80–100% of the pessary under the POP benefit. Medicare Part B covers HCPCS A4562 with a prescription through a Medicare-enrolled DME supplier; SciMed is not Medicare-enrolled, so SciMed purchases are not reimbursed by traditional Medicare. HSA/FSA both eligible.
A4562 is the HCPCS billing code for a pessary, non-rubber, any type. All silicone ring pessaries (including SciMed) are billed under A4562. The older A4561 code is for rubber pessaries and no longer commonly used.
Yes. Silicone pessaries qualify as medical expenses under IRS Section 213(d). Use your HSA/FSA card at checkout. For plans that require documentation, download our free LMN template.
Medicare Part B covers HCPCS A4562 with a prescription when the device comes from a Medicare-enrolled DME supplier or your clinician's office (allowable approximately $69–$89, varies by region; you pay 20% after the Part B deductible). Fitting visit billed separately under CPT 57160. SciMed is not a Medicare-enrolled DME supplier, so purchases from SciMed are not reimbursed by traditional Medicare. Pessaries are HSA/FSA eligible, and at $49.99 the device often costs less than a typical Medicare copay route through an enrolled supplier.
For HSA/FSA: often yes, especially for over-the-counter purchases. For Medicare: usually included in provider's fitting visit notes. Download our free LMN template for your provider to sign.
Silicone ring pessaries typically last 12–24 months of continuous use. Some patients get 3+ years with meticulous care. Replacement cost from SciMed is $49.99.
Vastly. SciMed pessary: $49.99, replaced every 12–24 months. Surgery for prolapse: $5,000–$20,000 out-of-pocket. See the full pessary vs surgery decision guide.
Return unopened sealed pouches within 30 days for a refund. Consult your provider about a different size or the with-support variant. If multiple types fail after 6 months, discuss surgical options. You've lost $50 and a few weeks — no lasting consequence.
Pregnancy, postpartum, menopause
A pessary is sometimes used during pregnancy under provider direction — for prolapse discomfort or, with a specific "Arabin cerclage pessary," for a short cervix at risk of preterm birth. Do not self-fit during pregnancy. Notify your OB if you become pregnant while using one.
Yes — starting at 6 weeks postpartum after provider clearance exam. Many postpartum women use a pessary for 6–18 months while pelvic floor tone recovers, then discontinue. See the postpartum pessary guide.
Yes. A silicone pessary releases nothing systemically. Breastfeeding does affect vaginal tissue tone (low estrogen), which may require a slightly smaller fit than post-weaning. Silicone strongly preferred over PVC for breastfeeding mothers.
Yes — one of the most common non-surgical treatments for post-menopausal prolapse. Post-menopausal patients often do best with topical vaginal estrogen (Estrace, Vagifem) alongside the pessary to reduce atrophy-related complications.
Topical vaginal estrogen (not systemic HRT) is often recommended alongside a pessary for post-menopausal patients — reduces atrophy, improves comfort, dramatically lowers erosion + recurrent BV/yeast risk. Discuss with your provider.
Yes. A ring pessary with support can dramatically reduce SUI by compressing the urethra. Many postpartum women use it during running/lifting and remove at night.
A pessary is not contraceptive — it does not prevent pregnancy. If you become pregnant while using one, notify your OB immediately.
Yes. The pessary is removed before a Pap smear or pelvic exam and re-inserted afterward. Does not affect exam results. Continue routine cancer screening on your normal schedule.
📖 More detailed guides
Most-Asked Pessary Questions, Answered Directly
How to change a pessary
To change a silicone ring pessary: wash your hands, remove the ring, wash it with mild soap and warm water, rinse it well, and reinsert it (or insert a clean second ring if you rotate two). Most ring users remove and clean theirs anywhere from daily to once a week, depending on their clinician's advice and their own comfort. There is no single required schedule for a ring pessary — the right routine is the one you can keep up comfortably.
How to clean a pessary
Wash a silicone ring pessary with mild soap and warm water, rinse thoroughly, and pat or air dry before reinserting. Do not use bleach, alcohol, or harsh detergents — they are unnecessary and can degrade the surface over time. While it is out, check the ring for cracks, stiffness, or damage; a medical-grade silicone ring normally lasts 1–2 years.
Pessary insertion — how to put a pessary in
For ring pessary insertion: wash your hands, fold the ring in half, and insert it like a tampon, guiding it so it sits behind the pubic bone and opens into place. A correctly fitted ring should not be felt once inserted. If you feel it, push it gently further back or remove and reinsert it. Ring pessary insertion does not need tools or a clinic visit once you know your size.
Can you remove a pessary yourself?
Yes. Most women who wear a ring pessary remove and reinsert it themselves — that self-management is one of the main reasons the ring is the most popular pessary type. Hook a finger around the rim, bear down slightly, and ease it out. If a ring feels stuck, do not force it; relax, change position (squatting helps), and try again. If it still will not come out, a clinician can remove it in seconds.
Can a pessary fall out?
Yes, a pessary can fall out — and it usually means the size is too small or the fit is not right, not that anything is wrong with you. If your ring slips or falls out, try the next size up. A multi-size fitting pack exists for exactly this reason: most women need to try two or three sizes before one stays comfortably through a full day, including bathroom trips and exercise.
Can you still have sex with a pessary?
Yes — a ring pessary can usually stay in during intercourse, and most partners do not notice it. If it causes discomfort for you or your partner, simply remove it beforehand and reinsert it afterward. (This applies to ring pessaries; some other pessary shapes must always be removed first.)
What size pessary do I need?
Ring pessaries come in sizes 0–10, from 1.75 inches (size 0) to 4.25 inches (size 10) in diameter, in quarter-inch steps. Most women fit sizes 3, 4, or 5. The reliable way to find your size without a clinic fitting is a fitting pack with three sizes: start with the middle size, and move up if it falls out or down if it feels like pressure.
What is a pessary device?
A pessary is a removable medical device worn inside the vagina to support the pelvic organs. It is the main non-surgical treatment for pelvic organ prolapse, and it also helps many women with stress urinary incontinence. Modern pessaries are made of soft, medical-grade silicone; the ring pessary is the most common type. In the US, silicone ring pessaries can be bought without a prescription.
What does pessary fitting involve?
Pessary fitting means finding the size that stays in comfortably and supports you through normal activity — you should be able to walk, sit, and use the bathroom without feeling it. Fitting can be done by a clinician, or at home with a multi-size fitting pack: try a size for a day, and adjust up or down until one fits. A correct fit should never hurt.
When should a pessary be removed?
Remove a ring pessary to clean it on your regular routine, and remove it and seek advice if you notice pain, bleeding, unusual discharge or odor, or trouble urinating. Otherwise a ring pessary is designed for everyday wear, including overnight, unless your clinician advises differently.
How to insert a pessary (and how to change one)
Inserting a ring pessary is a fold, a gentle push, and a fit check. The same steps cover how to change a pessary — remove the old one, wash it, and reinsert or replace it:
- Wash your hands and empty your bladder first.
- Fold the ring. Squeeze the soft silicone ring in half so it forms a narrow oval. A little water-based lubricant on the leading edge helps — never use silicone lubricant on a silicone pessary.
- Get comfortable: stand with one foot on a chair, squat, or lie on your back with knees bent.
- Insert the folded ring folded-end first, guiding it up and back. Let it open once it is inside, then push it gently up behind the pubic bone until it sits around the cervix.
- Check the fit: stand up, walk around, cough, and sit down. Fitted well, you should not feel it at all. If you can feel it, it is not in far enough — or the size is wrong.
- To remove it: hook one finger over the rim, fold the ring slightly, and ease it out slowly. Never pull a ring with support out by its membrane.
Full illustrated walkthrough: How to Insert, Remove and Clean a Vaginal Pessary at Home. If the pessary slips out when you use the toilet or exercise, that almost always means the size is off — go one size up, or find your fit first with the Fitting Pack. Sealed size exchanges at SciMed are free within 30 days, with a prepaid return label.
Pessaries should be fitted and used under the supervision of a qualified healthcare professional. This page is educational information, not medical advice.