Pessary vs surgery for pelvic organ prolapse
If you have pelvic organ prolapse, you have two main treatment choices: a pessary or surgery. Both work well. Neither one is the “first step” before the other.
A pessary is a real long-term choice that many women prefer and stay with for years. Surgery is a one-time fix for women who want a definitive repair. The right path depends on your symptoms, your goals, and how you want to live.
This page walks through both so you can compare them side by side.
How a pessary works
A pessary is a small, removable silicone device. You place it in the vagina, and it supports the organs that have dropped. Think of it as a built-in support that holds things in place.
You can wear it all the time, or take it out on a schedule to clean it. Some types you manage yourself at home. Others your doctor manages for you.
What to expect:
- We fit it in the office during a short visit. We try a few shapes and sizes to find the one that fits you best.
- Most women feel relief right away.
- Ring and dish pessaries can often stay in during sex. Space-filling types usually come out first.
- Follow-up visits run about every 3 to 6 months, or once a year if you care for it yourself.
A pessary fits most women. Even if you have risk factors that make fitting harder, it is still worth trying one if you want to. Prolapse stage does not predict whether a pessary will work for you.
How surgery works
Surgery rebuilds the support that has weakened. The two main approaches are vaginal repair using your own tissue (native tissue repair) and abdominal repair using mesh (sacrocolpopexy, often done robotically).
What to expect:
- Most repairs are outpatient or a short hospital stay.
- You take it easy for a few weeks while you heal. We ask you to avoid sex and heavy lifting, then add activity back as your body tells you it is ready.
- Surgery aims to correct the anatomy itself, so you do not manage a device day to day.
Side-by-side comparison
| Factor | Pessary | Surgery |
|---|---|---|
| What it is | A removable silicone device you wear | A repair done in the operating room |
| Anesthesia | None | Yes |
| Recovery | None. You use it right away | A few weeks of taking it easy |
| What it does | Holds the prolapse up while you wear it | Rebuilds the support itself |
| Ongoing care | You or your doctor clean and check it | Little day-to-day care once you heal |
| Reversible? | Yes. Take it out anytime | No, though another surgery is possible |
| Common risks | Vaginal irritation, discharge, sores (erosion) | Surgery risks; the prolapse can come back |
| Effect on sex life | No change in sexual function scores | Can improve sexual function |
What the research shows
A large national study (the Pelvic Floor Disorders Registry) followed women for up to 3 years. It tracked women who chose a pessary and women who chose surgery. Both groups did well.
Among women who kept using a pessary, 78% felt much or very much better at 1 year, and over 90% felt that way at 2 and 3 years. After the first year, very few women stopped. Most women who switch to surgery do so early, often because they planned on surgery from the start.
Women who chose surgery also did well. Fewer than 1 in 7 had their prolapse return in the first year, and repeat surgery was rare. One real difference: surgery improved sexual function and overall quality of life more than a pessary did. A pessary holds the prolapse up but does not change those scores much.
So this is not a contest where one option wins. It is about which trade-offs fit your life.
How I think about the choice
I do not see a pessary and surgery as competing. They are two valid endpoints, and the right one depends on you.
A pessary is a real long-term choice. Many women wear one for years and never want anything else. It avoids surgery, you can stop anytime, and it works for most women.
Surgery is the right call when you want a one-time, definitive repair and you would rather not manage a device. It also tends to do more for your sex life and overall quality of life.
Pelvic floor physical therapy can go alongside either path. It is more than Kegels. We have pelvic floor PTs in our office, plus a regional network across northeast Wisconsin and the Upper Peninsula of Michigan.
A pessary may fit you well if you
- Want to avoid surgery, now or for good
- Have health conditions that raise your surgery risk
- May want to get pregnant in the future
- Are comfortable with a small amount of upkeep
- Want relief right away
Surgery may fit you well if you
- Want a one-time, definitive repair
- Would rather not manage a device day to day
- Have symptoms that get in the way of daily life
- Care about restoring sexual function and quality of life
- Are healthy enough for an operation
Making your decision
There is no wrong answer. We will weigh what matters most to you, whether that is avoiding surgery, keeping upkeep low, or getting the most durable repair.
Some women choose a pessary and stay with it for years. Others choose surgery from the start. Both are good choices. We will go through your options together and help you feel sure about the path you pick.
References
- Andy UU, Meyn L, Brown HW, et al. Outcomes at 12, 24, and 36 months in women treated for pelvic organ prolapse with pessary or surgery: results from the multicenter Pelvic Floor Disorders Registry. Urogynecology. 2025. doi:10.1097/SPV.0000000000001669
- Yurteri-Kaplan LA, Meyn L, Moalli PA, et al. Outcomes of pessary use at 1 year in women treated for pelvic organ prolapse in a large multicenter registry. Urogynecology. 2022. doi:10.1097/SPV.0000000000001279
- Ferrando CA, Bradley CS, Meyn LA, et al. Twelve month outcomes of pelvic organ prolapse surgery in patients enrolled in the multicenter Pelvic Floor Disorders Registry. Urogynecology. 2023. doi:10.1097/SPV.0000000000001410
- Hooper GL, Moynihan L, Leegant A, et al. Vaginal pessary use and management for pelvic organ prolapse (AUGS-SUNA clinical consensus statement). Urogynecology. 2023. doi:10.1097/SPV.0000000000001293
- Carberry CL, Tulikangas PK, Ridgeway BM, et al. AUGS best practice statement: evaluation and counseling of patients with pelvic organ prolapse. Urogynecology. 2025. doi:10.1097/SPV.0000000000001641
- Committee on Practice Bulletins—Gynecology, American Urogynecologic Society. Pelvic organ prolapse. ACOG Practice Bulletin No. 214. Obstetrics & Gynecology. 2019.