The words ‘suppository’ and ‘pessary’ are used interchangeably in everyday language to mean a ‘vaginally inserted’ dosage form.

However, the medical terminology is a bit more pedantic. Medical terminology is prescribed in a Pharmacopoeia, an official publication containing a list and standards for medicines. Think of a dictionary for medical words. Each country has a Pharmacopoeia that they use as an official document for all things medicines, including the identity of actives, their strength, quality, and tests that medicines need to comply with.

The most reputable Pharmacopoeias used in the Western world are British Pharmacopoeia (BP) and United States Pharmacopeia (USP) and the National Formulary (NF).

British way of defining products for vagina

According to BP, the difference is:

‘pessary’ is a solid dosage form intended for vaginal administration. ‘suppository’ is a dosage form intended for application within the rectum.

US way of defining products for vagina

USP defines dosage forms for application into the vagina as either Vaginal Suppositories or Inserts, while Suppository as dosage forms adapted for application into rectum. When it comes to a Pessary, USP considers it as a medical device, not a medicine.

So who is right?

Therefore, in Europe and Australia a pessary is a correct way of expressing medicines for vaginal use. In USA, vaginal suppository is the most common way of defining a medicine for vaginal route of administration.

Forms of preparations

A pessary or vaginal suppository may deliver a medicine that can achieve either systemic or local effect. The active ingredients can also have ether intermediate effect or have sustained release and effect over a period of time.

Vaginal suppository or pessary can come in different forms:

• molded pessary (which melts at body temperature and typically includes base with cocoa butter, glycerinated gelatine, hydrogenated vegetable oils, mixtures of polyethylene glycols and their fatty acid esters)
• tablets (compressed pessary)
• soft capsule (shelled pessary)
• hard shell capsule (pessary)

Those dosage forms are specifically design for vaginal application ensuring the appropriate disintegration and release of active ingredients.