Evolving Pessary Patient Education – Improving the Perception and Uptake of Pessaries
Authors: Crystal Northcott, NP, MN, and Christine Goudie, PhD (student), MDes
December 9, 2025
Pessaries, as useful as they are, have often been overlooked as a solution for pelvic organ prolapse by many women based on their intimidating appearance and lack of patient education. When it comes to pessaries, improving patient education is key to shifting perceptions, empowering choice, and making non-surgical solutions more desirable for patients.
Pessaries, which are medical devices inserted into the vaginal canal to support the pelvic organs, are an effective treatment for pelvic organ prolapse (POP) and stress urinary incontinence (SUI). Though considered a first-line treatment for POP and SUI, many women receive insufficient education on pessary treatment, leading them to opt for surgical treatment instead, which can be life-altering and not without risks. Providing more advanced tools to better educate patients on pessaries can increase the uptake of this treatment method by helping patients understand that less invasive treatment methods can be effective and appropriate.
The Stats on Pessaries
Globally, POP affects up to 40% of women at some point in their lives [1], while SUI impacts up to 25% [2]. Risk factors for these conditions include aging, childbirth (in particular, vaginal deliveries), and obesity, all of which can weaken the pelvic floor and increase the likelihood of POP and SUI. Pessaries are specifically designed to help manage both of these conditions, providing essential support and relief.
These conditions also carry a significant financial burden for international healthcare systems. In the United States alone, the cost of surgical treatment for POP was estimated at $4.5 billion in 2023 [3], while annual expenditures for managing SUI are estimated to surpass $13 billion [2].
Treatment Options for POP
When it comes to managing POP and SUI, two commonly recommended treatment options are surgery and pessaries. Depending on the severity of the condition, both solutions have been shown to be effective at alleviating symptoms of POP and SUI [4]. Surgery aims to ideally restore the pelvic organs to their original positions; however, such invasive procedures have been linked to temporary relief and only modest long-term success rates. Furthermore, a 2022 meta-analysis reported recurrence rates of POP after surgery as high as 37.7% [5]. Some patients may experience new complications such as pelvic pain and dyspareunia, as well as the general risks associated with surgery, including infection, bleeding, and injury to surrounding pelvic organs [6]. The use of surgical mesh for POP surgery has also been linked to tissue damage from mesh erosion, leading to secondary health complications for the patient [6].
Pessaries, on the other hand, provide structural support by gently propping up the pelvic organs and are a low-risk, non-surgical option that can be easily inserted, removed, and adjusted, making them a less invasive and reversible alternative for many patients. Given their ease of use and lower risk profile, pessaries also have a lower financial burden on healthcare systems compared to surgical treatment.
Pessary Perceptions
A 2016 study published in Female Pelvic Medicine and Reconstructive Surgery explored patient knowledge and perceptions of pessaries to identify barriers to care for POP and SUI [7]. Researchers surveyed 254 new patients of urogynecology clinics at an academic medical centre and found that only 50% of respondents had knowledge of pessaries, and only 33% were willing to consider pessaries for treatment.
Even among women who choose to manage POP or SUI with pessaries, hesitations can still arise, particularly around ongoing care. For patients who choose to use pessaries, there are typically two options for ongoing management: clinic-based care or self-management. With clinic-based care, a qualified clinician is responsible for pessary maintenance, including removing, cleaning, and reinserting the device. This may require two to three appointments per patient annually.
In contrast, pessary self-management empowers patients to insert, remove, and care for their POP independently, offering greater autonomy and flexibility. Pessary self-management has been shown to result in fewer complications related to pessary usage and higher confidence levels in patients [8]. Recent studies found that the most common barriers to pessary self-management compared to clinic-based care include lack of confidence, fear of pain, and co-morbidities such as arthritis, which may make pessaries difficult to manipulate [9] [10].
This raises an important question: how can we address negative patient perceptions of pessaries and improve the way that pessaries are presented to patients as a treatment option?
Pessary Patient Education is Key
Patient education plays an important role in overcoming hesitations that women have regarding the use of pessaries, and in particular, pessary self-management. Research has found that women who receive education on pessary self-management are more likely to continue pessary use over time, rather than discontinuing use and seeking alternative treatments [11]. Patients are thought to continue their own pessary management based on developing confidence and comfort with pessary changes, and the at-home convenience [12].
In addition, studies have shown that women who were educated about pessary use through visual educational tools, like brochures and videos, as opposed to verbal instructions alone, were more confident and better prepared to manage their pessaries at home [13] [14]. Visual educational tools are important for patient education, as patient populations are often diverse, and verbal instructions may not be clear to all patients due to language or learning differences.
Visual educational tools that are accessible and culturally sensitive can transcend language barriers to improve overall device adherence. With improved access to practical education, women can feel more confident in choosing devices such as pessaries that are a safer alternative to surgery and are designed to improve their quality of life.
The authors would like to thank Rebecca Wytsma, B.A.Sc., for her contribution to the article.
Granville Biomedical is advancing patient education with the creation of the Iris model - an anatomically accurate teaching tool designed to demonstrate how pessaries work. Featuring a flexible, translucent vaginal canal, the Iris model allows healthcare providers to visually and physically demonstrate pessary insertion, positioning, and removal, making the process easier for patients to understand.
Patients can also use the Iris model for hands-on practice, helping them build confidence in managing their own care. By demystifying pessary use and making it less intimidating, the Iris model empowers more individuals to consider this conservative, non-surgical treatment option for POP and SUI.
References
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