Pelvic health rehabilitation has grown tremendously over the decades, expanding from a publicly viewed mentality of “just Kegels” to a comprehensive, whole-body, and whole-life approach. As rehabilitation providers, we now treat the complex interplay of muscles, fascia, organs, and the nervous system that influences bladder, bowel, and sexual health. But one area that is still underrepresented in many rehabilitation settings is pessary care.;

Pessary fitting has historically been performed by gynecologists and urogynecologists, but in more recent years, especially since the APTA released a position statement in favor of pelvic health physical therapists being able to fit pessaries in 2022, pessary care has entered the rehab scope of practice. Adding pessary fitting, management, and follow-up into a pelvic rehab practice can provide immense benefits for patients, providers, and the healthcare system at large.

Pelvic organ prolapse (POP) is incredibly common, affecting nearly half of people who have given birth. As pelvic health providers, we are not surprised to hear many patients are left with only two extremes: surgery or “wait and see.” We know that pelvic floor therapy can help POP, with things like lifestyle changes, bowel/bladder habit changes, support garments, pressure management, and exercise, but what about our patients who need more?

Pessaries provide a non-surgical, reversible, and evidence-based option that can dramatically improve symptoms of prolapse and stress incontinence. Pelvic rehab providers have been happy to provide traditional therapy options, but now we’re able to offer the additional option of pessary care if we have the right training and permissions from our licensing and state boards. Pelvic health rehabilitation providers already assess pelvic floor function, educate patients on anatomy, and provide individualized exercise programs. Integrating pessary fitting for appropriate patients is a natural progression or addition of this care.

Most of our patients are seeking pelvic therapy because they want to get back to the activities that matter. They come in with goals like running after their kids, practicing yoga without leakage, enjoying intimacy, or simply walking without pressure or heaviness. A pessary can act like a structural support “orthotic” for the pelvic floor, allowing therapy exercises to be more effective, reducing discomfort, and helping patients meet their functional goals faster. The amazing part about pessaries is that they can be used as short-term solutions, like for a run, or an all-day solution, like with a patient who stands for a 12-hour shift.

Why don’t pelvic rehabilitation providers just wait and refer to the “experts” for pessary fittings? Appointments with urogynecologists or surgeons can require long wait times, travel to urban centers, or may not even exist in rural areas. There is a possibility of higher expenses if a person goes to a larger facility and has a high deductible. In other countries (like Australia, Canada, France, and Germany, to name a few), rehab providers are the primary pessary fitters! And even in the US, there are many therapists who have been fitting pessaries for years, usually under the training and guidance of gynecologists or urogynecologists.

When rehabilitation providers offer pessary care, this expands access to conservative treatment for all patients, but especially those with less access to pessary care due to financial, scheduling, or access issues. For patients who feel dismissed in or apprehensive of traditional medical settings, the supportive, education-focused, trauma-informed environment of pelvic rehab can also reduce anxiety and improve outcomes.

Patients often see their pelvic rehab providers weekly, developing strong trust and rapport. This relationship may make a patient more open to learning about pessaries, asking questions, and following up regularly for fit checks and care. Integrating pessary education and management strengthens that continuum of care, reducing the drop-off that can occur when patients are bounced between multiple providers. Be mindful that fitting pessaries is an art and comes with a need to have a medical provider looped into the patient’s plan of care. Medical providers can help manage any potential skin issues, discharge issues, or infection. There will also be times when a rehabilitation provider does not have the skill set to meet the needs of a patient, and the patient needs to be referred to a more skilled or advanced provider.

For therapists, adding pessary care is not just about tools; it is also an opportunity for professional growth. Pessary fitting requires advanced clinical reasoning, commitment to whole-patient solutions, and adaptability to evolving best practices. From a business standpoint, it allows a clinic to differentiate itself, attract new referrals, and provide a comprehensive service that keeps patients within its continuum of care longer.

Current research shows that pessaries are safe, cost-effective, and highly acceptable to patients. Professional organizations (such as the APTA Academy of Pelvic Health and AOTA) recognize the need for interdisciplinary, conservative options in managing POP and incontinence. By adopting pessary care, rehab providers position themselves at the forefront of evidence-based pelvic health practice.

Ultimately, pelvic rehab is about giving patients the knowledge and tools to take ownership of their health. Implementing pessary care provides one more option, whether used as a long-term solution, a bridge to surgery, or a way to stay active and comfortable during postpartum recovery, high-impact activity, or menopause.

Adding pessary fitting to our skill set is not about replacing what we already do as pelvic rehab providers. Fitting pessaries can enhance our provider toolkit, help us collaborate with other providers, and meet patients where they are. When used alongside education, exercise, and behavioral strategies, pessaries can be life-changing. By implementing pessary care, pelvic rehab providers honor the true spirit of our profession: addressing the whole person, restoring function, and empowering patients with choices beyond the “surgery or nothing” dichotomy.

Take the Next Step: Learn Pessary Care in Practice
If you’re ready to expand your clinical toolkit and bring the benefits of pessary care to your patients, join us for Pessaries and Pelvic Rehab: Introduction to Pessary Fitting, Care, and Management.

This two-day, in-person continuing education course is designed for experienced pelvic rehab providers who want to integrate pessary fitting into their practice. With a blend of pre-course lectures and hands-on lab instruction, you’ll gain the advanced assessment skills, fitting techniques, and clinical reasoning tools to confidently and safely implement pessary care.

Upcoming Course Dates & Locations:

• Chicago, IL | November 8–9, 2025
• Tacoma, WA | January 31–February 1, 2026
• Houston, TX | September 12-13, 2026

This course features pre-course anatomy and POP modules, lab-based POP and vaginal dimension assessments, supervised pessary fitting practice, and a pessary fitting kit included with registration. Give your patients more options, strengthen your scope of care, and be part of the growing movement to integrate pessary care into pelvic rehabilitation.

AUTHOR BIO:
Mora Pluchino, PT, DPT, PRPC

Mora Pluchino, PT, DPT, PRPC (she/her) is a graduate of Stockton University with a BS in Biology (2007) and a Doctorate of Physical Therapy (2009). She has experience in a variety of areas and settings, working with children and adults, including orthopedics, bracing, neuromuscular issues, vestibular issues, and robotics training. She began treating Pelvic Health patients in 2016 and now has experience treating women, men, and children with a variety of Pelvic Health dysfunction. There is not much she has not treated since beginning this journey, and she is always happy to further her education to better help her patients meet their goals.

She strives to help all of her patients return to a quality of life and activity that they are happy with for the best bladder, bowel, and sexual functioning they are capable of at the present time. In 2020, she opened her own practice called Practically Perfect Physical Therapy Consulting to help meet the needs of more clients. She has been a guest lecturer for Rutgers University Blackwood Campus and Stockton University for their Pediatric and Pelvic Floor modules since 2016. She has also been a TA with Herman & Wallace since 2020 and has over 150 hours of lab instruction experience. Mora has also authored and instructs several courses for the Institute.

The Herman & Wallace course catalog does not include a pessary-focused course at the time of posting. Pelvic Organ Prolapse is discussed in Pelvic Function Level 1 and more in-depth in Pelvic Function Level 2B.

A pessary is a device that is placed in the vaginal canal to support the pelvic organs. They have been used by humans for millennia to treat pelvic organ prolapse (POP), being crafted of various materials from pomegranate to cork¹. Most modern-day pessaries are made of silicone, although some medical pessaries are even engineered to release estrogen. Recent research suggests that combining pessary use with pelvic floor muscle training for treating POP may be even more effective than pelvic floor muscle training alone².

A pessary 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 urethra¹. A 2024 study even indicated that they may improve sexual wellness in people with pelvic organ prolapse². 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 canal⁵.

Traditionally in the United States, pessaries have been placed by medical professionals rather than rehabilitation professionals (although some PTs at the Veteran 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.

If you are looking to include pessary fitting and management in your clinical toolkit, first check with your state physical therapy board to ensure that it is permitted where you practice. If your state does allow pessary fitting, select a class that ideally includes both didactic and lab-based coursework. Be aware that most will require a pelvic health fundamentals class with internal examination as a prerequisite. Once you have passed your pessary class, it will be important to maintain solid connections with advanced clinicians (i.e., trusted urogynecologists and gynecologists) who you can coordinate with on more complex cases, such as those that present with vaginal dermatoses or genitourinary syndrome of menopause.

Physical therapists specialize in showing clients how to tend 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 prolapse⁷.

Note: The author 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.

AUTHOR BIO
Ken McGee, PT, DPT

Ken McGee, PT, DPT, (they/he) is a queer transmasculine pelvic health physical therapist based in Seattle. Their mission is to bring greater awareness to the pelvic health needs of the LGBTQIA2S community. They enjoy mentoring other rehabilitation professionals to better care for people of all genders.

Ken received their Doctor of Physical Therapy from the University of Washington in 2014 and their board certification as a Women’s Health Clinic Specialist (WCS) in 2018. Ken has lectured nationally and internationally on birth tears. Their practice, B3 Physical Therapy and Wellness, centers on transgender and perinatal rehabilitation. Ken also provides peer bodyfeeding support and doula care.