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Pessaries and Recurrent UTIs: How These Devices Can Affect Your Risk

  • Writer: Angel Tumbaga
    Angel Tumbaga
  • Jul 13
  • 10 min read

Written and approved by Dr. Jasmine Bonder and Dr. Adam Bonder


Introduction: A Common Question With a Nuanced Answer


If you've been prescribed a pessary, or you're using one and have been dealing with recurrent UTIs, you've probably wondered whether the two are connected. The answer is yes, pessary use can increase UTI risk, but the relationship is more nuanced than a simple cause-and-effect.


The good news is that pessaries are still valuable, often life-changing devices for many women. They can support pelvic organs, relieve discomfort, manage stress urinary incontinence, and allow many women to avoid or delay surgery. The risk of UTIs that comes with them is real but highly manageable with the right care and strategies.


This article will walk you through what pessaries are, why they can increase UTI risk, how the risk varies depending on the type of pessary you use, and what you can do to support your urinary health while continuing to benefit from your pessary. Our goal is to give you clear, judgment-free information that supports your care.


If you'd like a printable companion resource to bring to your next appointment, you can grab our free Clinova UTI and bladder health guide here anytime.




What Pessaries Are and Why They're Used

A pessary is a removable medical device inserted into the vagina to provide support for pelvic organs or to improve urinary continence. Pessaries are typically made of silicone, although some older versions are made of rubber.


Pessaries are commonly used for:


  • Pelvic organ prolapse, where the bladder, uterus, or rectum has shifted from its usual position

  • Stress urinary incontinence, particularly leakage with activity or coughing

  • Avoiding or delaying prolapse surgery while maintaining daily comfort

  • Post-surgical support in some cases

  • Pregnancy-related support in certain situations


Different pessary shapes serve different needs, and finding the right fit usually involves working closely with a knowledgeable provider.



Why Pessaries Can Increase UTI Risk


The reasons pessaries affect UTI risk are biological and predictable. They're not a sign that the device is poorly designed or that anyone has done anything wrong.



Foreign Body Effect


Any object placed in the vagina creates a surface where bacteria can attach and accumulate. The vaginal environment is delicately balanced, and a long-term foreign body can disrupt that balance, even when the pessary is doing its intended job.


Microbiome Disruption


Pessary use can shift the vaginal microbiome, often reducing protective Lactobacillus and favoring conditions that increase BV, yeast, AV, and UTI risk. The vagina's natural defenses depend on this microbiome being intact, so disruption has downstream effects on urinary health.



The Underlying Anatomy


Most women who use pessaries already have prolapse or stress urinary incontinence. These conditions can independently raise UTI risk by causing:


  • Incomplete bladder emptying

  • Residual urine sitting in the bladder

  • Changes in normal urinary flow

  • Pelvic floor dysfunction


The pessary helps support the prolapse, but it doesn't fully reverse all of these effects. Some baseline elevated risk remains from the underlying condition.



The Low-Estrogen Factor


This is one of the most important and most overlooked factors. Most pessary users are perimenopausal, postmenopausal, or otherwise low-estrogen women. Low estrogen significantly compounds pessary-related UTI risk because:


  • Vaginal and vulvar tissue becomes thinner and more vulnerable

  • Protective Lactobacillus populations decline

  • Vaginal pH rises, favoring E. coli colonization

  • Tissue is more prone to irritation and erosion

  • Natural defenses against infection weaken


For most women using pessaries, addressing this estrogen factor is one of the single most impactful steps for reducing UTI risk. We'll come back to this.



Tissue Effects Over Time


Especially with longer-wear pessaries, the device can cause:


  • Subtle erosion of the vaginal lining

  • Areas of inflammation or irritation

  • Cumulative changes that affect the vaginal environment

  • Compromise of natural barrier function



Discharge and Local Environment Changes


Some pessary types can trap discharge or cause changes in the local environment that further favor harmful bacterial growth.




Key Differences That Drive the Risk


Across all pessary types, several factors determine where on the risk spectrum a particular device falls:


  • How frequently it can be removed and cleaned

  • How long it stays in continuous contact with tissue

  • Whether it uses suction (cube pessaries especially)

  • Surface area and size

  • Whether it can be self-managed or requires provider visits

  • How well it fits your individual anatomy



The Pessary, Prolapse, and UTI Triangle


For many women, the relationship between pessary use, underlying prolapse, and recurrent UTIs forms an interlinked picture:


  1. Prolapse causes incomplete bladder emptying and other UTI risk factors

  2. A pessary is placed to help with prolapse symptoms

  3. The pessary helps the prolapse but adds its own UTI considerations

  4. The combined picture (prolapse anatomy + pessary effects + often low estrogen) increases UTI risk meaningfully


Addressing UTI risk effectively in pessary users usually means looking at all three factors together, not just one.


If you're using a pessary and dealing with recurrent UTIs, you don't have to keep navigating this alone. Visit Clinova Solutions to learn how clinician-led telehealth care can help you build a thoughtful plan that supports your pessary use and your bladder health.



Signs Your Pessary May Be Contributing


Most women with pessaries don't experience constant UTIs. The following patterns suggest your pessary may be a meaningful contributor worth addressing:


  • UTIs that started or worsened after your pessary was placed

  • Recurrent BV or yeast infections alongside UTIs

  • Increased or changed vaginal discharge

  • Unusual or unpleasant vaginal odor

  • Spotting or light bleeding since pessary placement

  • Vaginal soreness, dryness, or rawness

  • Burning or discomfort with urination even between confirmed infections

  • Symptoms that flare around your cleaning or change schedule

  • A sense that something is different since starting the pessary


If any of these resonate, your pessary deserves a closer look as a possible contributing factor.



What Can Help: Universal Management Strategies


The good news is that pessary-related UTI risk is highly manageable when addressed thoughtfully. The following strategies apply across pessary types, although the specifics may vary.



Vaginal Estrogen: The Single Most Impactful Step for Most Women


For perimenopausal, postmenopausal, or otherwise low-estrogen women using pessaries, vaginal estrogen is one of the most evidence-supported tools available. It works by:


  • Restoring vaginal tissue thickness and resilience

  • Supporting protective Lactobacillus populations

  • Lowering vaginal pH back toward healthy levels

  • Reducing E. coli colonization

  • Reducing pessary-related tissue erosion

  • Decreasing UTI recurrence in this population


Vaginal estrogen comes in creams, tablets, and rings, and it can be used safely alongside a pessary for most women. Major professional societies recognize it as a safe option for the majority of postmenopausal women, including many with a history of certain cancers when used under guidance.


This is one of the most underused tools in pessary care, and discussing it with your provider is often the highest-yield conversation you can have.



Regular Removal and Cleaning


Follow your provider's protocol consistently:


  • Cube pessaries should be removed daily

  • Ring, dish, donut, and incontinence ring pessaries are typically removed and cleaned weekly or more often

  • Gellhorn pessaries are usually managed by a provider every one to three months


Don't extend intervals between cleanings or provider appointments, even if things feel fine. Microbiome and tissue effects build up gradually.



Optimize Your Fit


A pessary that's too large, too small, or the wrong shape can cause tissue pressure, irritation, and incomplete emptying that all increase UTI risk. Fit may need reassessment after:


  • Significant weight changes

  • Childbirth

  • Pelvic surgery

  • Progression of prolapse

  • Aging-related anatomical changes



Support the Vaginal Microbiome


  • Avoid douching, scented washes, and other vaginal irritants

  • Consider targeted probiotic strategies under guidance

  • Treat any active BV, yeast, or AV with proper protocols

  • Avoid unnecessary antibiotics when possible



Address Bladder Emptying


If your prolapse is affecting how fully your bladder empties, this is worth specifically evaluating. Strategies can include:


  • Pelvic floor physical therapy

  • Postvoid residual measurement

  • Behavioral techniques for complete emptying (leaning forward, double voiding)

  • Pessary fit adjustments



Hydration and General Care


Stay steadily hydrated to keep urine pale through the day. This supports natural bladder defenses and helps flush bacteria. Wear breathable cotton underwear, avoid scented hygiene products, and protect the vulvar microbiome with gentle external care only.



Track Symptoms


A simple journal noting pessary care, symptoms, and any flares can reveal patterns and help guide care over time.



Want a clear, easy-to-share resource you can bring to your provider to discuss pessary care and recurrent UTIs? Download our free Clinova UTI and bladder health guide.



When to Consider Adjustments or Alternatives


For most women, pessaries can continue to work well with proper management. In some cases, however, adjustments may be worth discussing:



A Different Pessary May Help


  • A different size or shape

  • A simpler ring instead of a larger device

  • A different pessary type entirely if the current one continues to cause issues

  • Newer materials or designs



Pelvic Floor Physical Therapy


For some women, pelvic floor PT can reduce the underlying prolapse or incontinence picture, sometimes reducing pessary dependence or making the device work better with less compression.



Surgical Evaluation


For women where pessary management isn't working despite all the supportive strategies, surgical repair of the underlying prolapse may eventually be the right path. This is a personal decision based on your overall situation.



Continuing Supportive Care


For many women, the most effective approach is keeping the pessary but adding layered supportive care: vaginal estrogen, more frequent cleaning, microbiome support, and addressing other contributing factors.



How to Talk to Your Provider


Useful questions to ask:


  • "Could my pessary be contributing to my recurrent UTIs?"

  • "Should I be using vaginal estrogen alongside my pessary?"

  • "Am I cleaning and removing my pessary often enough?"

  • "Could a different size or type of pessary be lower-risk for me?"

  • "Should I be evaluated for incomplete bladder emptying?"

  • "What's the comprehensive plan for protecting my urinary health while using my pessary?"


A good provider will welcome these questions. If yours doesn't, seeking care from a clinician who specializes in recurrent UTIs and women's health is a reasonable next step.



When to Seek Professional Support


Please consider reaching out to a qualified clinician if you experience:


  • Two or more UTIs in six months, or three or more in a year

  • New or worsening vaginal symptoms since starting your pessary

  • Discharge changes, odor, or spotting

  • Vaginal soreness, burning, or rawness

  • A sense that your pessary may be contributing to your symptoms

  • Difficulty with pessary care or cleaning

  • Pelvic pressure or pain that feels new


You should always seek prompt care for fever, back pain, chills, vomiting, blood in your urine, or significant vaginal bleeding.



How Clinova Solutions Can Help


Clinova Solutions specializes in caring for women with recurrent UTIs, chronic urinary symptoms, and the conditions that often surround them. We understand that pessary users are uniquely vulnerable to recurrent infections, and that thoughtful, layered care can make a real difference.


Our approach is built around:


  • Clinician-led telehealth care so you can access expert support from home

  • Personalized plans based on your unique history, hormones, anatomy, and goals

  • An education-first philosophy that helps you truly understand your body

  • Specialized expertise in recurrent UTIs and the wider range of conditions that surround them

  • Prevention-focused strategies designed to support long-term comfort and confidence

  • Hormonal optimization, including vaginal estrogen, as part of comprehensive care for pessary users when appropriate

  • Coordination with your gynecologist or urogynecologist for the most comprehensive approach


You deserve care that takes pessary-related UTI risk seriously and helps you build a plan that supports both your prolapse care and your urinary health.


To take a more informed next step, you can:




Frequently Asked Questions


Do pessaries really increase UTI risk?

Yes, although the risk varies depending on the type of pessary, how long it's worn between cleanings, and individual factors. The reasons include foreign-body effects, microbiome shifts, the often-low estrogen state of pessary users, and the underlying prolapse anatomy that led to needing a pessary in the first place.

In most cases, yes. The most impactful steps are using vaginal estrogen if you're perimenopausal or postmenopausal, following your cleaning and removal schedule consistently, ensuring proper fit, supporting your vaginal microbiome, and addressing any other contributing factors like incomplete bladder emptying.

Not necessarily. For most women, the right approach is to optimize pessary care rather than abandon the device. Adding vaginal estrogen, improving cleaning practices, ensuring proper fit, and addressing other contributing factors can significantly reduce UTI risk while preserving the benefits of your pessary.

For most women, yes. Vaginal estrogen works locally on vaginal tissue and is generally compatible with pessary use. It's one of the most important tools for reducing pessary-related UTI risk in perimenopausal and postmenopausal women. Talk to your provider about whether it's right for you.

This depends on the type. Cube pessaries should be removed daily. Ring, dish, donut, and incontinence ring pessaries are typically cleaned weekly or more often. Gellhorn pessaries are usually managed by a provider every one to three months. Follow your provider's specific protocol.

Yes. Pessary use can shift the vaginal microbiome in ways that favor BV, yeast, and AV. Many women with pessary-related recurrent UTIs also experience recurring vaginal issues. Addressing the microbiome is often part of the answer.

Often yes. Pelvic organ prolapse can cause incomplete bladder emptying, residual urine, and changes in normal urinary flow, all of which raise UTI risk independently of the pessary. Addressing both the prolapse picture and the pessary considerations together usually works best.

Possibly. A pessary that's slightly too large, too small, or the wrong shape can cause tissue pressure, irritation, and incomplete emptying. A refit conversation is reasonable, especially after weight changes, childbirth, surgery, or aging-related changes.

No. Pessaries serve important purposes, and the UTI risk associated with them is rarely communicated clearly when they're first prescribed. Having this information now simply gives you more tools to manage your care effectively.

Anytime your UTIs are recurrent, your pessary is causing discomfort or vaginal symptoms, or you want to explore strategies for reducing your risk. Earlier conversations often lead to easier, more effective change.



Follow Along for Ongoing Recurrent UTI Education & Support


Healing starts with understanding what's really going on in your body, and you should not have to figure it out alone.


We regularly share educational content about recurrent UTIs, bladder health, pelvic floor dysfunction, hormones, microbiome balance, prevention strategies, and evidence-informed approaches to chronic urinary symptoms across our social platforms.


Follow us for:

  • Recurrent UTI education

  • Prevention tips and symptom support

  • Bladder health insights

  • Expert-backed wellness content

  • New videos resources

  • Real conversations women are not hearing elsewhere


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We’re here to help women feel informed, supported, and empowered through every stage of their healing journey.



This article is for educational purposes only and is not a substitute for individualized medical advice. Please consult a qualified clinician about your specific symptoms and health history.

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