Ring Pessary With Knob Self-Care Instructions

The Ring pessary with Knob is made of a flexible silicone material and comes in many sizes. It has two inside notches which are folded in two to reduce its size for easy insertion and removal.

It must be removed 1 night per week to protect your vaginal walls and vaginal flora / secretions.

 

How to insert a Ring Pessary with Knob: 

Wash your hands and pessary with warm water and soap.
Find a position you feel relaxed, comfortable and able to reach your vaginal opening:
  • Sitting on the edge of a chair or toilet or bed.
  • Deep squat.
  • Standing with a leg up on a chair or toilet seat or bed. If you are right handed, put your left foot up on the surface.
  • Lying down with knees bent.  
If your prolapse sits close to, or out of the vaginal opening, you need to push and reinsert the bulge up as high as you can. Fold the pessary in half so that the ends are pointing downwards. (see picture below.) 
Lubricate the edge of the pessary which you will first put in your vagina. Avoid getting lubricant on your hands or anywhere else on the pessary as it can make it too slippery to insert.
Breathe in and out and relax your pelvic floor muscles.
Part the labia with your non-dominant hand.  These fingers can also help guide the pessary inside, keeping the pessary folded over.  
Angle the tip of the pessary towards the back of your vaginal opening and gently slide it up your back vaginal wall as far as possible before releasing. 
Once inserted, use your finger(s) to push the ring up as high as it can go comfortably, aiming towards your tailbone. 

Rotate the Ring until the knob is sitting towards the front, the indentations are then placed sideways.

You can then push the knob upwards to sit behind the pubic bone (it may then return to a lower angle and that's fine). 

 

 

How to remove a Ring pessary with Knob:

Wash your hands with warm soapy water and dry them.
Find a position you feel relaxed, comfortable and able to reach your vaginal opening:
  • Sitting on the edge of a chair, toilet or bed.
  • Deep squat.
  • Standing with a leg up on a chair or toilet seat or bed. If you are right-handed, put your left foot up on the surface.
  • Lying down with knees bent.  
Reach a finger up and rotate the ring so that an indentation is lower most to allow folding and easier removal. 
Hook your index finger behind the pessary and pull it down and out of your vagina.  It will naturally fold inwards as you remove it.  
 
Note: Do not panic if you are having difficulty removing the pessary. Try a different position, and bear down by “straining” or coughing. If you do not succeed, then contact your physio or GP who will  be able to help you. If you cannot contact your physio or GP and are in pain or cannot empty your bladder and bowel you can go to your nearest hospital accident and emergency and tell them that you have a vaginal pessary that may be causing a problem. 

Different positions for insertion and removal:

Postions to insert and remove pessary

How to clean the Ring Pessary with Knob:

A Ring pessary with Knob should be removed weekly and left out overnight or for a 24 hour period. 
Once you have removed the pessary:

  • Wash with mild soapy water by rubbing pessary with your fingers or a soft brush. Rinse well. 
  • Rinse the pessary well with water. 
  • Dry the pessary completely with a clean paper towel or clean cloth and allow to air dry.
  • Check the pessary for any obvious cracks or signs of wear.
  • Store in a dry, safe place (plastic container or wrapped in a clean cloth) if not re-inserting immediately. 
  • Discolouration of the pessary often occurs and is not harmful.

When should I have the pessary checked or changed?

After the initial fitting, you should attend a review appointment at:

  • 1-2 weeks: to review your ability to remove and insert and to check the pessary is comfortable. It is also important to check for good bladder and bowel emptying.
  • 3-4 months: to check that the vaginal mucosa is tolerating the regular pessary wearing. 
  • 1 year: this annual review should be with your GP or gynaecologist so they can check the health of your vaginal walls via speculum exam.  You will also need to see your pessary physiotherapist for a replacement pessary and to check if your pessary type or size is still appropriate.  

If you have any concerns about the fit of your pessary, please contact your physiotherapist to arrange a review.

Do I need to use vaginal oestrogen with the pessary?

If you have been prescribed vaginal oestrogen, you will need to continue using it as maintenance (usually 1-2 times/week as per your GP's recommendation) whilst using the pessary.  This can improve the condition of the vaginal walls and may protect them from injury, reducing your risk of infection or ulcers. 

Can I have sex whilst wearing the pessary?

Yes.  However, some couples find it noticeable or uncomfortable and choose to remove it for sex. 

How do I manage my period whilst wearing the pessary?

A Ring pessary with Knob allows for good menstrual flow so you may not need to remove during your period. Sanitary pads or period underwear will be your best menstrual protection and you may find using tampons possible with the pessary in.  Remove your pessary if you prefer to use a menstrual cup.