The Use of Vaginal Pessaries for Pelvic Organ Prolapse

Resident doctors in obstetrics and gynaecology have limited exposure to, and confidence with, urogynaecology, especially conservative management of pelvic floor dysfunction. Despite this, general gynaecologists and trainees will often be referred to for troubleshooting difficult fittings in advanced pelvic organ prolapse (POP) and managing related complications. This learning objectives and key content for this education article are as follows: evidence for using pessaries to manage POP; instruction on assessing POP with a validated system (POP‐Q) and assessing suitability for pessary fitting; types of pessaries, including their relevant applications, merits and drawbacks, and under‐used types; selection of suitable pessaries; their sizing and fitting; follow‐up required for safe maintenance of pessaries, including self‐management; common complications arising from pessary use (increased discharge, bleeding, erosions, fistulae) and their management; and national guidelines and current research studies relevant to pessaries. These objectives will be discussed in the context of high‐quality consensus guidelines from the UK Continence Society and the International Urogynecology Consultation, the latter published recently (2025). This education article adds to existing literature by summarising best available evidence from the UK and internationally to generate a practical, useful resource, covering additionally challenging ‘craft’ topics, like pessary fitting, in some detail.