Pessary Fittings
In order to fit pessaries I have completed both the WHTA POP/SUI (pessary fitting practical) course, and the WHTA advanced pessaries course. I have also completed a PGCertHSc (Women’s Health) at the University of Auckland (2025).
I practice alongside a gynaecologist in a monthly pessary clinic at Shore Women on Wednesday’s, where I assist Dr Marriot in the pessary fitting and management of her clients.
Vaginal pessaries are effective in supporting vaginal prolapse and enhancing bladder continence. In certain cases, they can also aid the posterior wall (rectocele).
Typically crafted from medical-grade silicone, vaginal pessaries come in various shapes and sizes to meet your needs. For information on how to manage your pessary, refer to the sections on “self-management” and “clinician management” below.
This involves a recent speculum and bimanual examination (within the last six months) and ensuring your cervical screening is current. You can have this done at your GP's office or with a gynecologist, and arrangements can be made following your initial appointment if necessary.
Pessaries typically cost $100 per device.
A comprehensive pelvic exam is necessary to determine your pessary options. In some cases, a speculum may be required, and you'll be asked for additional consent if this examination is needed. During your appointment, we will present and discuss various pessary options to identify the best fit for your lifestyle and preferences while addressing the anatomical corrections required, and ensuring clinical appropriateness.
Pessaries can be a bit of trial and error to get the right fit. While many patients achieve an ideal fit during their first session, others may face challenges that require careful consideration of anatomical factors, clinical presentation, and personal preferences. There are also occasions when a pessary may not work as anticipated. Sometimes onward referral for a review with a gynaecologist is required.
Fitting Process
The Fitting Process
As always, a full assessment is required where your history is discussed, along with goals and impact on your function and daily life. Prolapse can affect continence, bowels, pain, exercise, and sexual function, and discussion is often around how your prolapse is affecting you.
An initial assessment is required for fitting. If the device is in stock, your fitting can occur at this session, but sometimes you need to come back for a short follow up fitting session. I recommend the pessary is replaced annually, at your annual review.
All initial fittings require:
Fitting Session
1-2 week review
3 month review
Clinician Management
Clinician management is where the pessary is left in place and reviewed regularly, typically between 2 to 4 times a year (every 3 to 6 months) where the pessary is removed by your clinician, washed and inspected. A speculum is used to assess vaginal walls for any signs of wear or abrasions. The cleaned pessary is then placed back into the vagina, or replaced if required.
Self Management
Self-management involves the ability to independently insert and remove your pessary as needed, and this process can look different for everyone.
If you choose to self-manage, it's important to still attend your fitting reviews as previously mentioned. After your three-month review, you will be responsible for managing your pessary until your annual check-up, when it is due for replacement.
Assuming there are no complications, only annual check-ups will be necessary thereafter. These appointments will include a pelvic examination and a speculum exam to ensure that continued use of the pessary remains appropriate.
Option 1 – Removal Twice a Week (Most Common)
The pessary is used continuously and should be removed every 3-4 days for cleaning and drying. It is advisable to leave the pessary out overnight after removal, with reinsertion scheduled for the following morning.
Option 2 – Nightly Removal
In this approach, you wear the pessary throughout the day and remove it each night for cleaning and drying. This option is particularly beneficial for those bothered by excessive discharge, or concerned about potential abrasions, such as post-menopausal women or those who are breastfeeding.
Option 3 – Activity-Based Use
Some women find they only need their pessary for specific activities, such as running longer distances. lifting heavy weights, or even during times of illness. In this case, you can choose to use the pessary solely during the activity and remove it upon completion.