Pessary vs surgery for pelvic organ prolapse
If you have pelvic organ prolapse, your two main treatment choices are a pessary and surgery. Both work well, and you don’t have to try one before the other.
A pessary is a real long-term choice that many women stay with for years. Surgery is for women who want a repair and would rather not manage a device. The right path depends on your symptoms, your goals, and how you want to live.
How a pessary works
A pessary is a small, removable silicone device. It sits in the vagina and holds up the organs that have dropped.
You can wear it all the time, or take it out on a schedule to clean it. Some women manage it at home. Others have me take care of it in the office.
What to expect:
- I fit it in the office. It often takes a few tries, and sometimes more than one visit, to find the shape and size that fits you best.
- I see you back within about 4 weeks, since most fitting problems show up early.
- After that, office visits run every 3 to 6 months, or about once a year if you care for it yourself.
- Ring and dish pessaries can often stay in during sex. Space-filling types usually come out first.
A pessary can be fit in most women. Prior hysterectomy, prior prolapse surgery, or a larger body size can make fitting harder, but I’ll still try one if you want it. How far the prolapse has dropped doesn’t predict whether a pessary will work for you.
How surgery works
Surgery rebuilds the support that has weakened. The main approaches are:
- Native tissue repair: a vaginal repair using your own tissue
- Sacrocolpopexy: a repair through small belly incisions that uses mesh, often done robotically
- Colpocleisis: a shorter operation that closes the vaginal canal, for women who don’t plan to have vaginal sex again
What to expect:
- Many women go home the same day.
- Most women are back to normal activities in about 4 to 6 weeks. The main limit is nothing in the vagina for at least 6 weeks. Strict lifting limits don’t have good evidence behind them. See recovery from prolapse surgery.
- Once you heal, there’s no device to manage.
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 | About 4 to 6 weeks |
| What it does | Holds the prolapse up while you wear it | Rebuilds the support itself |
| Ongoing care | Regular cleaning and checks | Little day-to-day care once you heal |
| Reversible? | Yes. Take it out anytime | No, though another surgery is possible |
| Common problems | Vaginal sores, discharge, falling out | Surgery risks; the prolapse can come back |
| Effect on sex life | No change in sexual function scores | Sexual function scores improve |
What the research shows
A large national registry, the Pelvic Floor Disorders Registry, followed women for up to 3 years after they chose a pessary or surgery. Both groups did well, but in different ways.
About 1 in 3 women stopped using their pessary in the first year. Common reasons were choosing surgery, discomfort, the pessary falling out, or not enough relief. After the first year, few women stopped. Among women who kept using one, 78% felt much or very much better at 1 year, and over 90% felt that way at 2 and 3 years.
Sores inside the vagina were the most common pessary problem. About 3 in 10 women had at least one over 3 years. They usually heal with a short break from the pessary and vaginal estrogen.
Women who chose surgery also did well. More than 9 in 10 felt much or very much better at every check. About 1 in 7 had some sign of the prolapse returning in the first year, but fewer than 1 in 10 needed more treatment, and a second operation was rare. Surgery also improved sexual function and overall quality of life more than a pessary did.
Either treatment can change how your bladder works. Some women start leaking urine once the prolapse is held up or repaired. I check for hidden leakage before we decide.
How I approach it
I offer a pessary to every woman with prolapse that bothers her, and I offer surgery too. I don’t see them as competing. They’re two good endpoints.
A pessary avoids surgery, you can stop anytime, and it works for most women who stick with it past the first few months. Surgery makes sense when you want a repair and would rather not manage a device.
Pelvic floor physical therapy can go alongside either path. We have pelvic floor PTs in our office.
Women whose goals go unmet end up unhappy with either treatment, so I start by asking what you want to get back to.
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 fine with some upkeep
- Want relief without a recovery period
Surgery may fit you well if you
- Want a repair and don’t want to manage a device
- Couldn’t get a pessary to fit or stay in
- Have symptoms that get in the way of daily life
- Care about sexual function and quality of life
- Are healthy enough for an operation
Next steps
If you’re deciding between a pessary and surgery, schedule a visit. Come ready to tell me which symptoms bother you most and what you want to be able to do again. You can try a pessary first and still choose surgery later, or go straight to surgery.
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 with uterovaginal or posthysterectomy vaginal prolapse 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. Urogynecology. 2023. doi:10.1097/SPV.0000000000001293
- Carberry CL, Tulikangas PK, Ridgeway BM, et al. American Urogynecologic Society 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.
- Ashmore S, Samsel T, Collins SA, et al. Patient reported recovery after surgery. Urogynecology. 2026. doi:10.1097/SPV.0000000000001815