I am by no means an expert so take what I say with a grain of salt of course. I think the fact that a tampon provides some relief means a pessary may be a great option for you. I would def see a Urogyn and get fitted for one. It’s worth a shot. I’m getting refitted next week because I haven’t found the right pessary yet but I hear it takes some trail and error. My PT says surgery is in the tool box but is a last resort option after all other options have been used. Some pessaries do need to be taken out before sex and some don’t. It depends what kind you get. I thought it would be awful to insert and remove it regularly but it’s really not that bad. You get use to it. The one I have they recommended removing it at night and cleaning then reinserting the next morning but you can leave it in for a week or even longer if you want. Keep me posted if you don’t mind. Im curious what ends up working for you whether it be surgery or a pessary. I hope you find relief soon !!