Pessaries & Pelvic Rehab

A pessary is a device that is placed in the vaginal canal to support the pelvic organs. They can be worn only during an activity that typically provokes symptoms, such as running, or used almost continuously with periodic cleaning. People looking to avoid or delay pelvic organ prolapse surgery, such as those planning to give birth, may especially benefit from pessary use. Many transgender and nonbinary people with a front canal also find pessary use helpful for reducing POP symptoms.

Pessaries have additional benefits beyond improving prolapse symptoms. For example, some pessaries are designed to mitigate urinary incontinence by applying pressure to the urethra (1). A 2024 study even indicated that they may improve sexual wellness in people with pelvic organ prolapse (2). One case study series suggests that intersex people who have undergone vaginoplasty or neovaginoplasty may also benefit from pessary use for maintaining the patency of the canal (5).

Traditionally in the United States, pessaries have been placed by medical professionals rather than rehabilitation professionals (although some PTs at the Veterans Affairs were involved in fitting pessaries under the guidance of urogynecologists). In 2021, the American Physical Therapy Association’s Academy of Pelvic Health convened a Pessary Task Force to look at the feasibility of physical therapists fitting and managing pessaries. In 2022, the Academy of Pelvic Health released its position statement to include pessary fitting and management in the scope of practice of pelvic health physical therapists in the United States and its five territories. By the end of 2022, the Academy of Pelvic Health hosted its first pessary fitting course. Several more courses have been offered since then. Physical therapists specialize in showing clients how to tend to and support their bodies. Active participation in pessary fitting and management is a way to help the nearly 40% of people with vaginal canals who are expected to develop pelvic organ prolapse. 

If you would like to learn more, Herman & Wallace now has a pessary course! Pessaries and Pelvic Rehab is a two-day in-person course designed for pelvic therapists interested in adding pessary fitting to their clinical practice and have completed Pelvic Function Level 1 and Level 2B. Pessaries and Pelvic Rehab is scheduled for Chicago, IL on November 8-9, 2025. We look forward to seeing you there!

Note: HW does not currently know of any occupational therapists fitting pessaries in the United States, but they hope that this becomes a part of OT scope in the future.

References

1. Shah SM, Sultan AH, Thakar R. The history and evolution of pessaries for pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct. 2006;17(2):170-175.
2. Jin C, Yan H, Shang Y, et al. Real-world clinical effectiveness of nonsurgical treatments for female with POP-Q stage II cystocele: a retrospective analysis of therapeutic efficacy. Transl Androl Urol. 2024;13(4):483-492.
3. Petter Rodrigues M, Bérubé MÈ, Charette M, McLean L. Conservative interventions for female exercise-induced urinary incontinence: a systematic review. BJU Int. Published online July 23, 2024.
4. Nemeth Z, Vida P, Markovic P, Gubas P, Kovacs K, Farkas B. Long-term self-management of vaginal cube pessaries can improve sexual life in patients with pelvic organ prolapse, results from a secondary analysis. Int Urogynecol J. Published online August 5, 2024.
5. Mensah V, Christianson MS, Yates M, Tobler K, Kolp LA. Novel use of a pessary to maintain vaginal patency following vaginoplasty or neovaginoplasty for mullerian anomalies or agenesis. Fertility and Sterility. 2013;99(3):S37.
6. Wang B, Chen Y, Zhu X, et al. Global burden and trends of pelvic organ prolapse associated with aging women: An observational trend study from 1990 to 2019. Front Public Health. 2022;10:975829.