Pelvic Organ Prolapse · Patient guide

Pessary vs Surgery for Pelvic Organ Prolapse: Which Is Better?

Neither is better for everyone: a pessary is a safe, reversible first-line option that holds prolapsed organs in place, while surgery repairs the support itself and gives a more durable result for women who want a permanent solution. Pessaries suit women who prefer to avoid or delay an operation; surgery suits those whose symptoms persist despite a pessary. At Somssi Women's Clinic in Seoul, Dr. Yoon discusses both before recommending either.

Medically reviewed by Dr. Yoon Ho-joo, MD, PhD, OB/GYN specialist, Somssi Women's Clinic · Last updated October 2026

At a glance

Key facts

The essentials, based on how Somssi Women's Clinic performs this procedure or answers this question. Your plan is confirmed at consultation.

• Pessary: removable silicone device fitted in the vagina; works immediately; no anesthesia
• Surgery at Somssi: native-tissue repair with hysteropexy, posterior wall repair and pelvic floor strengthening
• Surgery time: about 50 minutes to 1 hour
• Anesthesia: sedation plus long-acting local; local alone on request
• Hospital stay: none; same-day discharge after urinating
• Intercourse after surgery: 7–8 weeks; a pessary may need removal before intercourse depending on type
• Who decides: you, after examination and a discussion of both paths with Dr. Yoon Ho-joo, MD, PhD

A pessary and surgery solve pelvic organ prolapse in different ways: a pessary props the dropped organs up from inside the vagina for as long as you wear it, while surgery rebuilds the support so you no longer need a device. Which is "better" depends on your stage, your health, whether you want to avoid an operation, and how you feel about managing a device long-term.

How a pessary works

A pessary is a soft silicone ring, dish or cube that sits in the upper vagina and holds the bladder, uterus or rectum back in position. It is fitted in the clinic in a few minutes, works at once, and can be removed at any time. Many women manage their own pessary, taking it out at night or before intercourse and reinserting it in the morning.

Pessaries are endorsed by the American College of Obstetricians and Gynecologists and the International Urogynecological Association as a legitimate first-line option for women of any age with symptomatic prolapse. They are especially useful if you are planning more children, have medical conditions that make anesthesia risky, or simply want to see how much relief support would bring before committing to an operation.

The downsides are practical. A pessary does not change the underlying anatomy, so symptoms return as soon as it is out. Some women experience discharge, odor, irritation or small vaginal erosions, particularly after menopause, and need regular check-ups or vaginal estrogen. Fitting can take several attempts, and a proportion of women cannot keep one in comfortably, especially with a wide vaginal opening or a short vagina.

How surgery works

Pelvic organ prolapse repair restores the structures that have stretched. Depending on which compartments have dropped, this can involve lifting and fixing the uterus (hysteropexy), repairing the front or back vaginal wall, closing the cul-de-sac at the top of the vagina, and rebuilding the pelvic floor muscle at the opening.

At Somssi Women's Clinic, a surgical gynecology clinic in Gangnam, Seoul, founded in 2000 and led by Dr. Yoon Ho-joo, MD, PhD, repair is done through the vagina using your own tissue, without mesh. The posterior vaginal wall is thickened by peeling the mucosa to under 1 mm, gathering the muscle layer and suturing in two layers; the uterus is repositioned and fixed rather than removed; and a figure-8 strengthening stitch supports the pelvic floor at the opening. You can read the full technique on the uterine prolapse surgery page.

Surgery takes about an hour under sedation plus long-acting local anesthesia, with discharge the same day. The trade-off is a real recovery period and real surgical risks: bleeding, infection, injury to the rectum or cul-de-sac, pain with intercourse, and the possibility that prolapse recurs years later.

Pessary vs surgery: side by side

Who tends to do well with a pessary?

• Women with stage 2–3 prolapse who want relief without an operation.
• Women who are not finished having children.
• Women with heart, lung or other conditions that make anesthesia unwise.
• Women who want to "try before they decide" whether restoring support fixes their symptoms.
• Women waiting for travel, work or family schedules to allow a recovery period.

Who tends to choose surgery?

• Women whose pessary falls out, causes irritation or simply feels like a daily burden.
• Women with laxity or a wide opening alongside the prolapse, which both weakens pessary retention and affects sexual sensation.
• Women with stage 3–4 prolapse who are otherwise fit.
• Women who want one definitive treatment rather than lifelong device management.

What the clinic's experience suggests

Dr. Yoon's position, formed over more than 25 years of pelvic floor surgery, is that surgical reconstruction gives a more durable and more complete result than a pessary, because it addresses the thinned vaginal wall and weakened pelvic floor rather than bracing against them. The clinic describes pessaries as a largely superseded option for women who are fit for surgery; that is the clinic's view, and international guidelines continue to list pessaries as a reasonable first choice.

What we can say without controversy is this: a pessary is an excellent way to confirm that restoring support will relieve your symptoms. If it does, and you dislike wearing it, surgery is likely to help you. If you are happy with a pessary, there is no medical reason to operate.

Women already using a vaginal ring who are considering a permanent repair can read about pessary removal and how it is timed with surgery.

When to see a doctor

Seek an assessment if a bulge is visible or persistent, if you need to push on the vaginal wall to pass urine or stool, if a pessary is causing bleeding or pain, or if you cannot keep one in. International patients can arrange an English-language consultation that includes examination and both options in one visit.

Bottom line

A pessary is safe, reversible and immediate; surgery is durable and definitive but involves recovery and risk. Many women reasonably try a pessary first and move to surgery only if it fails or becomes a burden. In the clinic's experience, surgical repair gives the more lasting result, but the right answer is the one that matches your anatomy, your health and how you want to live.

Questions patients ask

Frequently asked questions

Short, honest answers. For anything personal, a consultation is the right place to ask.

See the full FAQ →

Can a pessary make prolapse worse?

No. A properly fitted pessary does not accelerate prolapse, and some studies suggest it may slightly reduce progression by relieving strain on the tissues. Problems arise only if it is the wrong size or neglected, which can cause erosion or infection. Regular checks, and vaginal estrogen after menopause, keep most women comfortable.

How long can I use a pessary?

For as long as it remains comfortable and the tissue stays healthy, which can be many years. Some women use one for the rest of their lives. Others stop within the first year because of discharge, difficulty with insertion or because they decide they would rather have the prolapse repaired.

Can I have intercourse with a pessary in?

With a ring pessary, many women can. Space-occupying types such as the Gellhorn or cube usually need to be removed first. If you manage your own pessary this is simple; if not, it is one of the practical reasons some women eventually prefer surgery.

Will surgery definitely cure my prolapse?

Surgery repairs the support and relieves symptoms in the large majority of women, but no operation carries a guarantee. Prolapse can recur over years, particularly with heavy lifting, chronic cough, constipation or further tissue thinning after menopause. Read Can pelvic organ prolapse come back after surgery? for detail.

Is surgery safe for women in their 60s and 70s?

Usually yes, provided general health allows sedation or local anesthesia. Vaginal native-tissue repair done under local and sedation, with same-day discharge, is well tolerated by many older women. Your medical history, medications and heart and lung health are reviewed before any decision.

What if I try a pessary and still want surgery later?

That is a common and sensible path. Using a pessary first does not make later surgery harder. If anything, it confirms that supporting the organs relieves your symptoms, which makes the decision to operate clearer.

Keep reading

Related treatments and guides

• Pelvic Organ Prolapse Repair — the surgical option described in this comparison
• Vaginal Ring (Pessary) Removal — timing pessary removal with a permanent repair
• Pessary for Uterine Prolapse: Does It Work? — pessary results specifically for a dropped uterus
• Can Pelvic Organ Prolapse Be Treated Without Surgery? — every non-surgical option in one place
• What Surgery Is Used for Pelvic Organ Prolapse? — the operations compared
• Can Pelvic Organ Prolapse Come Back After Surgery? — honest talk about recurrence
• Native Tissue Vaginal Surgery — why the clinic repairs without mesh

Sources and medical review

• American College of Obstetricians and Gynecologists (ACOG) — practice guidance on pelvic organ prolapse, including pessary use
• International Urogynecological Association (IUGA) — patient information on pessaries and prolapse surgery
• Te Linde's Operative Gynecology — surgical management of pelvic organ prolapse

Next step

A consultation first. A decision only when you are ready.

Tell us what you are experiencing and what you hope to change. Dr. Yoon examines, measures and explains the options, including when no surgery is the right answer. International patients can start with an online consultation before travelling to Seoul.