A pessary for your prolapse
what you may not have KNOWN
Originally shared in December 2025 on Substack
In my ebook, Pressure Down There, I dedicated a whole chapter about pessary use. I consider them part of the holistic management for pelvic organ prolapse (POP), considering that they do not require surgery or medication. They used to be considered “old lady” devices. When it comes to POP, I always assess whether a patient would benefit from it. And you know what? Many women would actually benefit.
Below, I share in the audio recording what I’ve learned about pessaries from professional experience, including what they are and how to use them. I normally reserve the audio recording for paid subscribers, but I’m just so excited about what I’m about to share, I’m making it available for everyone!
*Fun fact: One of the pessary types is a donut. Some names are based on their shape, while others are named after male doctors.
Keep in mind that in the past, urogynecologists and urologists were the medical doctors who “fitted” women for pessaries, at least here in the US. If you’re lucky, a gynecologist might fit you. But the reality is, it’s not so easy to find a doctor who incorporates pessary fittings for patients with prolapse symptoms or even stress urinary incontinence (SUI: bladder leaking). I know this firsthand as I have to provide these resources for patients. After all, I’m the one recommending the device as part of their plan of care.
I’ve come to learn that the doctors don’t particularly enjoy fitting for these devices. They are surgeons! And what do surgeons love to do? Surgery, not pessary fittings. So they hand these tasks over to the nurse practitioner (NP), the physician’s assistant (PA), or the midwife. Except, what I notice now is that it’s not so simple as making an appointment and having a fitting with the NP.
As most patients in the US want to use their expensive medical insurance, rightfully so, they will want to use said insurance for said doctor visit. Well, as it turns out, the doctor's office makes you play along with their medical insurance game. First, you meet with the NP or PA. Then, on another visit, you meet with the medical doctor. And only after seeing the medical doctor, are you able to be fitted for a pessary. Regardless of when you are fitted, you must have a follow-up to make sure everything is going as it should.
Do you see the problem here?
Why does it require so many visits before an actual fitting for a pessary? It’s all part of the insurance game, but let’s talk about that BS of a system another time.
Some PTs in other countries get right to the point; they have the authority and education to fit and manage patients with a pessary. In the US, this was not possible—until very recently.
In my frustration with the broken system we will not fully get into at the moment, I decided to direct my frustration towards a solution. Fortunately, other PTs were just as frustrated and demanded the same authority as other PTs outside of the US.
It’s our job as PTs to fit patients for orthotics and prosthetics. A pessary is actually not that different. In the last several years, the Pelvic Health Academy via the American Physical Therapy Association (APTA), established a course to teach us pelvic floor PTs how to fit and manage patients with a pessary.
Guess who enrolled in the next class that came to the NY area?
Yup!
That’s me in the front right, with the rest of my lovely classmates and instructors whom I had the pleasure of intimately getting to know as well (yes, we fit for each other).
When I used to send patients to urogyns or urologists for fittings, with coaching on how to best convince the doctor to fit them for a pessary, I will simply do it myself! No more coaching, no more convincing, no more unnecessary appointments where you still don’t get a fitting!
During my training, I was not only trained on how to fit and manage pessary use, but I experienced one myself! And you know what? I kinda love it!
With the right fit, it can be really, really helpful for most women, especially if you leak a little pee when you cough, laugh, or sneeze. (Extra) Especially if you leak when you run or jump, are peri- or postmenopausal, or have other symptoms of prolapse. And if you’re used to wearing an estrogen ring, menstrual cup, or disc, it’s an especially easy learning curve.
If you’re in town and would like to be fitted for a pessary, or are out of town and would benefit from a consultation to know if you’re a good fit for a pessary, you know how to reach me.
Check out the audio recording here.
You can now book an appointment for a pessary fitting with Dr. Kenael. If you’re working with another pelvic floor therapist, you can request a pessary fitting or come in for a full pelvic floor evaluation if you don’t have a PT.