Prolapse and Pessary management

Prolapse of the uterus (womb) and/or walls of the vagina — with the bladder or bowel sitting behind them — is a common condition affecting up to 50% of women. It is commonly referred to as 'pelvic organ prolapse (POP)'.

Prolapse is associated with symptoms of heaviness, bulging, dragging, or functional changes such as difficulties with bladder or bowel emptying, discomfort with intercourse, or leakage.

Prolapses usually occur due to weakness of the supporting structures (muscles, ligaments) of the vagina. This can occur during childbirth, from chronic heavy lifting or straining, or as part of the ageing process — menopause is a common time to notice prolapse symptoms.

Prolapses are graded from 1 (mildest) to 4 (most severe). Your symptoms may not always match the grade — every woman is different. What matters most is how you feel.

There are several evidence-based options for managing prolapse. These are not mutually exclusive — many women benefit from a combination. There is no obligation to pursue any particular option.

Watch and wait:
Pelvic floor muscle training (PFMT)
Vaginal support pessary:
Surgery

What is a pessary?

A pessary is a removable silicone medical device that acts as a support within your vagina, helping to hold your pelvic organs in place. By providing this support, prolapse symptoms can be reduced or eliminated.

Pessaries come in different types, sizes, and shapes. Finding the right fit may take a little trial and adjustment — that is normal. Some women wear a pessary all day; others only use it for specific activities that trigger symptoms.

Most pessaries are made from soft, non-absorbent medical-grade silicone
A small number contain metal — your therapist will advise you if yours does (relevant for MRI and CT scans)
The pessary cannot migrate elsewhere in your body when used correctly
Pessaries are replaced annually at your 12-month review appointment

Who is suitable for a pessary?

Most women are suitable. You are not suitable if you have any of the following:

Pelvic inflammatory disease or active vaginal/pelvic infection
Known allergy to silicone
Vaginal or cervical cancer, or previous pelvic radiotherapy
Undiagnosed vaginal bleeding
Inability to comply with self-management and follow-up requirements
Vaginal atrophy: If you have dry, thin vaginal tissue — common during menopause or while breastfeeding — your GP may prescribe topical oestrogen cream for at least two weeks before your pessary fitting. This is a routine precaution.

Risks and complications

Complications are listed from most common to rare:

Vaginal discharge or odour — common; contact clinic if discharge changes colour, becomes copious, or smells unpleasant
Discomfort — should resolve within 12–24 hours; contact clinic if ongoing
Expulsion — pessary falls out; contact clinic if frequent
Vaginal tissue changes — abrasions or ulcerations; symptoms include bleeding, increased discharge, pain. Remove and contact clinic
Bleeding — post-menopausal or inter-menstrual bleeding is not normal; remove and contact clinic and GP urgently
Bladder and bowel changes — new or increased symptoms; remove and contact clinic
Neglected pessary (rare but serious) — risk of septicaemia, fistula, and death if regular reviews are missed

What does fitting involve?

Prior to commencing with a pessary fitting you will need a review from your GP to ensure you are up to date with a pelvic health screen and your vaginal mucosa can tolerate a pessary. The GP along with your physiotherapist will also go through any contraindications and precautions prior to use.

A vaginal examination will be performed to assess your prolapse. A speculum examination checks your vaginal mucosa. Once the most suitable pessary is selected, this will be fitted. Each pessary has a different way of fitting. The fitting process may be mildly uncomfortable at the time, but any discomfort should be gone within 12 -24 hours. You will then perform a range of activities — walking, coughing, jumping, squatting, toileting — to confirm the pessary stays in place. A post-void bladder scan will be completed before you leave.

How long will my pessary last?

Profem pessaries (the ones we commonly use at Female Focus) need to be replaced annually. However, they need to be checked at regularly for any development of cracks or fissures on the surface. If that occurs, they need to be replaced to prevent any increased risk of infections or breakages. The outer layer of the pessary can become discoloured, this is normal and isn’t of a concern.

Fees

Initial fitting appointment (approx. 45 minutes): $280 — includes appointment fee, pessary, and replacement if needed.

Follow-up appointments: standard follow-up fee. Replacement pessaries at future appointments will be confirmed with you in advance.

Fees effective from 1 January 2026 and subject to change.