A pessary is a medical device, typically made of silicone, that is inserted into the vagina to provide structural support for pelvic organs or to help manage urinary incontinence. This non-surgical option treats conditions like pelvic organ prolapse, where organs shift from their normal position. Minor vaginal bleeding or spotting is a recognized and common adverse event associated with the device’s use. This occurrence is usually related to mechanical factors and not necessarily a sign of a serious complication.
The Direct Relationship: Why Pessaries Cause Bleeding
The most frequent cause of minor bleeding when using a pessary is simple mechanical friction against the delicate vaginal wall tissue. Because the device is designed to hold its position and provide support, its edges may rub against the mucosa, especially during physical activity or with body movements. This constant, low-level irritation can result in superficial vaginal mucosal erosion, which is the most commonly reported complication of pessary use. This type of minor abrasion often manifests as light spotting or a pinkish tinge on the device itself upon removal.
Bleeding can also be linked to the normal process of inserting and removing the pessary, particularly if the device is not adequately lubricated. Minor trauma can occur to the vaginal entrance or walls during handling, leading to transient spotting that quickly resolves. A significant factor is the condition of the vaginal tissue itself, especially in post-menopausal individuals who may experience vaginal atrophy. Atrophy involves the thinning and drying of the tissue due to lower estrogen levels, making the vaginal walls more fragile and susceptible to breakdown from the pressure of the pessary.
When the tissue is thin and dry, the irritation caused by the pessary is exacerbated, increasing the likelihood of developing small lesions or superficial erosions that require attention to tissue health. The bleeding resulting from these mechanical issues is usually light and stops once the pessary is removed or the tissue heals.
Identifying Serious Causes and When to Seek Medical Attention
While minor spotting is common, persistent or heavy bleeding is a sign that a medical evaluation is immediately necessary. A poorly fitting or neglected pessary can cause significant, localized tissue damage, progressing from superficial erosion to deeper ulceration. These ulcers represent a more serious breakdown of the vaginal lining and require prompt removal of the pessary to allow for healing.
Infection is another serious complication that can be signaled by bleeding alongside other symptoms. Signs of infection may include a heavy, foul-smelling discharge, persistent pain, or a fever. Prolonged ulceration can lead to a fistula, which is an abnormal connection between the vagina and an adjacent organ like the bladder or rectum.
It is also important to recognize that a pessary does not protect against unrelated gynecological conditions that can cause bleeding, such as uterine polyps or cervical issues. Any unexplained vaginal bleeding must be assessed by a healthcare provider to rule out these or other underlying pathologies. A user should contact their doctor immediately if they experience heavy bleeding, bleeding that persists even after the pessary is removed, severe pain, or a fever.
Strategies for Prevention and Management
Preventing pessary-related bleeding begins with ensuring the device is correctly sized and fitted by a clinician. A proper fit ensures the pessary provides support without placing excessive tension or pressure on the vaginal walls, which can lead to erosion. Regular follow-up appointments are necessary so the clinician can periodically check the vaginal tissue for any signs of irritation or erosion before they become problematic.
Users who manage the device themselves should adhere to a strict schedule for removal and cleaning, as advised by their doctor, to prevent the buildup of secretions and bacteria that can irritate the tissue. Using a water-based lubricating gel during insertion and removal can significantly reduce the risk of mechanical trauma and friction against the vaginal entrance. For individuals experiencing tissue thinning due to atrophy, a doctor may prescribe a low-dose vaginal estrogen cream to improve the integrity, thickness, and resilience of the vaginal tissue, helping it better withstand the pressure of the pessary and minimize the risk of bleeding.