A pessary and surgery are both effective treatments for pelvic organ prolapse. A pessary is a removable silicone support fitted in the office that relieves symptoms with no operation. Surgery repairs the support itself and offers a lasting fix, with recovery time and surgical risks. The right choice depends on your symptoms, health and priorities.
There is no single correct answer. Some women love the freedom of a pessary and never think about surgery. Others find a pessary a nuisance and feel relieved after a repair. Choosing a pessary first never closes the door to surgery later. This guide compares daily life, care, intimacy and results so you can decide with confidence.
At a glance: making the choice
- Treatment is optional. If prolapse does not bother you, watching it is safe.
- A pessary is a valid long-term option, not just a stopgap, and can be tried in one visit.
- Surgery makes sense when a pessary does not fit, is not wanted, or symptoms are severe.
- Think about your priorities: avoiding surgery, sex, exercise, future pregnancy and how much upkeep you want.
What Is a Pessary and How Does It Work?
A pessary is a soft, flexible silicone device placed in the vagina to hold up the bladder, uterus, rectum or top of the vagina. It works like an internal support, pushing the dropped walls back into place. It is fitted in the office in one visit, and most women cannot feel a well-fitted pessary.
Pessaries come in many shapes and sizes, so finding the right one may take a second fitting.
| Type | Shape | Often used for | Self-care |
|---|---|---|---|
| Ring with support | Flexible ring with a thin membrane | Mild to moderate prolapse, any compartment | Easy to remove and reinsert; intercourse often possible with it in |
| Gellhorn | Disc with a stem | More advanced or uterine prolapse | Harder to remove yourself; usually office care |
| Donut or cube | Thick ring or soft cube | Advanced prolapse when other shapes fall out | Removed regularly; office or self-care |
| Incontinence pessary | Ring with a knob under the urethra | Leakage with exercise, with or without mild prolapse | Often worn only during activity |
What Is Life Like With a Pessary?
Most women go about normal life with a pessary in place: work, walking, travel and most exercise. You should not feel it, and you can urinate and have bowel movements normally. Regular cleaning, either by you or in the office, and vaginal estrogen for many women keep it comfortable.
- Self-care: many women learn to remove the pessary, wash it with mild soap and water, and reinsert it about once a week, or remove it overnight.
- Office care: if you prefer, it is removed, cleaned and checked every three to four months.
- Vaginal estrogen: after menopause, a low-dose cream protects the tissue and reduces irritation.
- Common nuisances: more discharge or odor, occasionally a sore spot; both are usually easy to fix.
- If it falls out: wash it and call us; a different size or shape usually solves it.
Tip: Bring a list of what matters to you to the fitting, such as running, lifting grandchildren, intimacy or traveling, so the shape and size can be matched to your life. Constipation pushes a pessary out, so keeping stools soft matters.
When Is Prolapse Surgery the Better Choice?
Surgery is often the better choice when a pessary keeps falling out or causes irritation, when you do not want ongoing upkeep, when prolapse is advanced and very bothersome, or when you want the most durable repair. Your health, age, sexual activity and whether the uterus is still present all shape which operation fits.
| Surgical option | What it involves | Often a fit for |
|---|---|---|
| Native tissue repair | Through the vagina, rebuilding the front or back wall with your own tissue | Bladder or rectal prolapse, no abdominal incisions |
| Apical suspension | Attaches the top of the vagina to strong pelvic ligaments, often with hysterectomy | Uterine or vaginal vault prolapse |
| Sacrocolpopexy | An abdominal procedure, often laparoscopic or robotic, using a mesh strip to lift the top of the vagina | Selected women with recurrent or advanced apical prolapse |
| Colpocleisis | Closes most of the vaginal canal; short operation | Women who are not sexually active and want a very durable fix |
Since 2019, mesh placed through the vagina for prolapse is no longer sold in the US. Read more about the options on our pelvic organ prolapse treatment and vaginal reconstructive surgery pages.
Want to try a pessary, or talk about surgery?
Dr. Solafa Elshatanoufy fits pessaries in the office and performs prolapse repair, so you hear about every option from one specialist at our Katy office. New patients are welcome.
Pessary vs Surgery: Side-by-Side Comparison
| Pessary | Surgery | |
|---|---|---|
| Procedure | Office fitting, no anesthesia | Operating room, anesthesia |
| Recovery | None | Usually several weeks of limited lifting |
| Relief | Immediate, while it is in place | Lasting repair; prolapse can return in some women |
| Upkeep | Cleaning and checks for as long as you use it | Follow-up visits after surgery |
| Sex | Possible with some shapes, or remove it first | Usually possible after healing (except colpocleisis) |
| Future pregnancy | Compatible | Usually delayed until childbearing is complete |
| Main risks | Discharge, irritation, sores | Bleeding, infection, bladder changes, recurrence |
| Can you change your mind? | Yes, stop at any time | A pessary can still help if prolapse returns |
When to seek immediate medical evaluation
- You cannot urinate or have a bowel movement with a pessary in place
- Heavy bleeding, foul discharge with fever, or severe pain with a pessary
- A pessary that is stuck and cannot be removed
- Fever, heavy bleeding or inability to urinate after prolapse surgery
Go to an emergency room or call 911 in an emergency.
How Do I Decide?
Start by asking what bothers you most and what you want to protect: avoiding an operation, a sex life without a device, running without thinking about it, or keeping childbearing options open. Many women try a pessary first, which is low-risk and shows how much better they feel once supported.
- Leans toward a pessary: you want to avoid surgery, plan more pregnancies, have health conditions that raise surgical risk, or want relief now while you decide.
- Leans toward surgery: a pessary does not stay in or irritates, you want no upkeep, or prolapse is advanced and limits your life.
- Either way: pelvic floor physical therapy supports both choices.
Your Care Team
Dr. Solafa Elshatanoufy, MD, PharmD
Board-certified urogynecologist. Pessary fitting and prolapse surgery.
Oyindamola Gbadamosi, FNP
Pessary checks, cleaning visits and ongoing care.
Sonya Asghari, PT
Pelvic floor physical therapy before and after treatment.
Prolapse Care in Katy and Greater Houston
Katy Women’s Pelvic Health is at 410 W Grand Pkwy S, Suite 320, Katy, TX 77494, near I-10 and the Grand Parkway. Women from Katy, Fulshear, Cypress, Sugar Land, Richmond and Houston are seen here, Monday to Friday, 8:00 AM to 5:00 PM. Read our guide to vaginal bulge causes and prolapse stages.
Key Takeaways
- A pessary relieves prolapse without surgery and is a valid long-term choice.
- Ring pessaries are easy to care for yourself; other shapes may need office cleaning.
- Surgery offers a lasting repair, with recovery time and surgical risks.
- Native tissue repair, apical suspension, sacrocolpopexy and colpocleisis suit different women.
- Trying a pessary first never rules out surgery later.
Frequently Asked Questions
Can a pessary cure prolapse?
A pessary does not repair the prolapse, but it holds the organs in place and relieves symptoms as long as it is worn. Some women with mild prolapse who also do pelvic floor therapy notice less prolapse over time.
Can you have sex with a pessary in?
With a ring pessary, many women and partners can have intercourse with it in place. Other shapes, such as the Gellhorn, need to be removed first. You can also remove a ring before sex and replace it afterward.
How often does a pessary need to be cleaned?
Women who remove their own pessary usually clean it with mild soap and water about once a week. Others have it removed and cleaned in the office every three to four months.
What are the side effects of a pessary?
The most common are increased vaginal discharge or odor and, less often, irritation or small sores where the pessary rubs. Vaginal estrogen and regular checks prevent most problems.
Who is a good candidate for prolapse surgery?
Women whose prolapse is bothersome and who could not get relief with a pessary or therapy, or who prefer a lasting repair, and who are healthy enough for an operation.
Is it OK to choose a pessary long-term?
Yes. Many women use a pessary for years. It is a valid long-term choice, not a second-best option, and you can still choose surgery later.
Choose with a specialist who offers both
Book a visit with Dr. Solafa Elshatanoufy in Katy to talk through a pessary, surgery or both.
