Although vaginal pessaries are widely used in the conservative management of urogynecologic conditions, access to their fitting and ongoing follow-up often remains limited. Over-the-counter (OTC) vaginal support devices may offer a more accessible alternative for conservative management of stress urinary incontinence and pelvic organ prolapse. Current theories attribute the efficacy of these devices to mechanical support of pelvic structures or their space-occupying properties; however, the neuromuscular effects of vaginal support devices on pelvic floor muscles have not been investigated.

The aim of this study was to evaluate the acute neuromuscular effects of an OTC vaginal support device, the Pippa (non-significant risk), on the levator plate angle (LPA) and puborectalis muscle stiffness during rest, maximal voluntary contraction (MVC), and maximal bearing down, in asymptomatic women. We tested the null hypothesis that insertion of the device would not change the LPA or puborectalis muscle stiffness in the three contraction states tested.

A single-group, pre–post mechanistic study was conducted in fifteen asymptomatic women aged 20–39 years. Transperineal B-mode ultrasound and shear wave elastography (SWE) were used to assess pelvic floor neuromuscular function with and without the Pippa device inserted. Imaging was performed in supine hooklying; order was randomized for device condition and imaging modality.

Participants performed three standardized tasks: rest, contraction, and bearing down. LPA was measured from the inferior pubic point to the anorectal angle relative to a horizontal reference line [1]. Puborectalis muscle stiffness was quantified in kilopascals (kPa) using SWE with standardized regions of interest [2].

Two-way repeated measures ANOVAs examined the interaction effects of the device and contraction state. Pairwise comparisons were used to compare mean differences. Additionally, change scores from rest to contraction and rest to bearing down were analyzed to normalize changes to resting muscle tone once the device was inserted.

LPA measurements did not show a significant interaction effect between device and contraction states (p = 0.88).
Puborectalis muscle stiffness showed a significant device and contraction state interaction (p = 0.016). During contraction, the puborectalis muscle stiffness was significantly greater without the device than with the device (p=.04) (Table 1). During bearing down, the stiffness was greater in the device condition, but the difference was not significant when comparing simple means. Change-score analysis confirmed that the device increased muscle tone significantly (p=.03) from rest to bearing down compared to the control condition.

The device did not restrict or enhance expected elevation or depression of the pelvic floor in asymptomatic women, supporting its functional compatibility with normal pelvic floor mechanics. The observed increase in puborectalis muscle stiffness during bearing down suggests a neuromuscular effect that may reduce excessive tissue deformation during tasks with increased intraabdominal pressure. The decrease in stiffness during contraction while wearing the device is not well understood; it may be related to offloading the pelvic floor muscles or potential changes to the length-tension relationship of pelvic floor muscles when using the device.

These findings expand the current mechanistic understanding of vaginal support devices beyond structural support models to include potential neuromuscular modulation of the pelvic floor muscles while maintaining functional range of motion.

This is the first study to evaluate the neuromuscular effects of an OTC vaginal support device using elastography. This mechanistic study provides early evidence that the device preserves voluntary pelvic floor movement and resting tone while improving resistance to deformation during bearing down in asymptomatic women. Further research in symptomatic, perinatal, and perimenopausal populations is needed to determine clinical efficacy of symptom management and prevention of pelvic floor dysfunction associated with excessive strain.

1.	Frawley H, Shelly B, Morin M, Bernard S, Bo K, Digesu GA, Dickinson T, Goonewardene S, McClurg D, Rahnama'i M, Schizas A, Slieker-ten Hove M, Takajasji S, Voelkl Guevara J. An International Continence Society (ICS) Report on the Terminology for Pelvic Floor Muscle Assessment. Neurourol Urodyn. 2021 DOI: 10.1002/nau.24658
2.	Morin M, Salomoni SE, Stafford RE, et al. Validation of shear wave elastography as a noninvasive measure of pelvic floor muscle stiffness. Neurourol Urodyn 2022;41(7):1620–1628.

Continence 19S (2026) 102582
DOI: 10.1016/j.cont.2026.102582