A pessary is a removable, non-surgical device placed into the vagina to provide physical support for pelvic organs, commonly used to manage symptoms associated with pelvic organ prolapse (POP). This occurs when organs like the bladder or uterus descend from their normal position. Pessaries also help some individuals manage stress urinary incontinence (SUI) by supporting the urethra. When considering a pessary as a long-term solution, a frequent question revolves around how many years the device can be used and what ongoing maintenance is required to ensure safety and effectiveness.
Continuous Use and Device Lifespan
Many people successfully use a pessary for an indefinite period as a sustained alternative to surgery. Studies tracking long-term use demonstrate that a significant percentage of patients continue to use the device successfully for many years, with some data showing continuation rates of over 33% at the ten-year mark. The duration a patient wears a pessary is distinct from the physical lifespan of the device itself.
The majority of modern pessaries are manufactured from medical-grade silicone, a material chosen for its durability, hypoallergenic properties, and resistance to absorbing secretions. A silicone pessary, with proper care and regular cleaning, can often last for several years, with typical replacement windows ranging from three to five years. In contrast, older or less common materials like rubber or polyvinyl chloride (PVC) often degrade much faster, sometimes requiring replacement every few months.
Replacement is necessary if the device shows signs of cracking, splitting, discoloration, or loss of its original shape and flexibility. Additionally, if the pessary begins to feel less effective or if the patient’s pelvic support needs change, a healthcare provider may need to refit or replace the device with a different size or shape.
Required Clinical Follow-Up and Cleaning Schedules
Safe, long-term pessary use relies heavily on a consistent routine of clinical follow-up appointments. For individuals who cannot or prefer not to manage the device themselves, a healthcare provider must remove, clean, and reinsert the pessary at scheduled intervals. Clinical guidelines often recommend this professional cleaning and examination occur every three to six months to prevent complications and assess the vaginal environment.
During these routine visits, the clinician removes the device to perform a thorough cleaning and inspects the vaginal walls for any signs of tissue irritation or injury. The provider then determines if the existing pessary is still suitable or if a new one is required due to wear or a change in the required fit.
Many patients are taught self-management. For these individuals, the recommended at-home cleaning frequency is typically daily or weekly, using mild soap and warm water. Self-managing patients still require less frequent clinical check-ups, often annually, to ensure the fit remains appropriate and that no unseen complications are developing. This self-care regimen significantly reduces the number of required office visits and contributes to the long-term success of the treatment.
Addressing Long-Term Safety Concerns
Continuous use of a pessary over many years requires careful monitoring for specific adverse health outcomes. The most commonly reported minor complication is a change in vaginal discharge, which can sometimes indicate an alteration in the natural vaginal flora, such as vaginitis or bacterial vaginosis. While a thin, watery discharge is common, any discharge accompanied by a foul odor, itching, or burning should be promptly evaluated.
Clinicians also vigilantly monitor the vaginal lining for pressure-related injuries, such as vaginal wall erosion, which are reported in a percentage of long-term users. These erosions occur when the device exerts constant pressure on the tissue, and they are frequently managed by temporary pessary removal and the use of topical estrogen therapy. Post-menopausal patients often benefit from the use of vaginal estrogen cream, as it helps thicken and strengthen the vaginal lining, thereby reducing the risk of atrophy and erosion.
Severe complications, such as the formation of a fistula (an abnormal connection between the vagina and the bladder or rectum) or the device becoming embedded in the vaginal wall, are rare. These issues typically develop when the pessary has been neglected and not removed for cleaning and inspection. Patients are advised to immediately contact their provider if they experience symptoms like pelvic pain, unexplained vaginal bleeding, or difficulty with urination or bowel movements.