Removing and Cleaning Your Own Pessary: What the TOPSY Trial Found
Bladder & Pelvic FloorArticleMany women with a prolapse pessary go back to a clinic every few months to have it taken out and cleaned. A UK trial of 340 women compared that with learning to manage the pessary yourself, after one 30-minute lesson. Quality of life was the same at 18 months and at 4 years, there were fewer complications at 18 months, and it cost less. Here is what self-management involves and who it suits.
In this article
A pessary is a device worn in the vagina to support a prolapse. It usually needs taking out and cleaning from time to time, and for many women that means a clinic visit every few months. The TOPSY trial tested another option.
The trial
The trial enrolled 340 women across UK pessary clinics who had already worn a pessary for at least two weeks.1 Half kept their routine clinic appointments. The other half learned to manage the pessary themselves with:1
- A 30-minute teaching appointment
- An information leaflet
- A follow-up phone call at 2 weeks
- A helpline number for the clinic
What it found
| At 18 months1 | At 4 years2 | |
|---|---|---|
| Prolapse quality of life | No difference between groups | No difference |
| Complications | Fewer in the self-management group | 18% vs 22%, not a significant difference |
| Cost | Self-management was cost-effective | Still cost-effective |
Women who self-managed felt more confident handling their pessary.1 The authors concluded self-management is an effective long-term option.2
The limits: the trial wasn’t blinded, and only about half the women answered at 4 years.12 Women with limited hand dexterity, memory problems or some pessary types (shelf, Gellhorn or cube) weren’t included.1
Is it for you?
Self-management may suit you if you can comfortably reach and handle the pessary, and you’d rather skip some clinic trips. Ask your clinic:
- “Is my type of pessary one I could take out myself?”
- “Could you teach me, and how often should I remove and clean it?”
- “Who do I call if something goes wrong?”
Keep your clinic’s number handy for bleeding, unusual discharge, pain or trouble peeing or opening your bowels.
For more, see what pelvic organ prolapse is, questions before trying a pessary and sex with a pessary.
Try: “I’ve had my ring pessary for a year and I come in every six months to have it changed. Could I learn to take it out and clean it myself?”
Laugh, Sneeze, Jump covers pessaries in Chapter 9, “When It’s Been Years,” in a section called “The Next Rungs.” It lays out the options above pelvic floor training, from a fitted pessary to surgery, and which ones fit leaks with effort. See the book.
This article is for general educational purposes only and is not medical advice. It isn't a substitute for diagnosis or treatment from a qualified healthcare professional who knows your health history. Only remove or reinsert a pessary after you've been taught by your clinic, and follow their schedule. Contact your clinic for bleeding, unusual or smelly discharge, pain, trouble peeing or opening your bowels, or a pessary that falls out or won't come out. Girl Playbook does not endorse any specific product, test, or provider.
Girl Playbook sells this book. It provides education and worksheets, not individualized medical care.
Sources
The research behind this article, in the order it’s cited. How we source our articles.
- Health Technology Assessment (via PubMed Central), 2024Clinical and cost-effectiveness of pessary self-management versus clinic-based care for pelvic organ prolapse in women: the TOPSY RCT with process evaluation (opens in a new tab)abcdef
- BJOG (via PubMed Central), 2025Four Year Clinical and Cost Effectiveness of Vaginal Pessary Self-Management Versus Clinic-Based Care for Pelvic Organ Prolapse (TOPSY): Long Term Follow-Up (opens in a new tab)abc
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