A pessary is a removable medical device, typically made of silicone, that is inserted into the vagina to provide physical support for the pelvic organs. Its primary function is to manage the symptoms of pelvic organ prolapse, a condition where pelvic structures like the bladder or uterus descend from their normal position. The device is also frequently used to help treat stress urinary incontinence by providing support to the urethra. This non-surgical treatment option is often preferred by patients who wish to avoid or delay surgery, or who are not suitable candidates for an operation.
The Lifespan of Pessary Treatment
The pessary therapy itself has no inherent time limit and can be used effectively for many years. Studies tracking long-term use demonstrate that a significant number of women continue to benefit from pessaries for five years or longer. Continued usage is dependent on the device remaining comfortable and successfully managing the patient’s symptoms.
The decision to continue this treatment modality rests on patient satisfaction and regular medical monitoring. Some data indicates that over 30% of ring pessary users continue treatment for 10 years or more. While the median duration of use in some studies is around 3 to 5 years, this often reflects a patient’s choice to pursue surgery or other reasons for discontinuation, rather than a failure of the long-term treatment option.
Factors Determining Device Replacement
While the treatment itself is indefinite, the pessary device does have a specific lifespan and requires replacement. Most modern pessaries are constructed from silicone, a durable material that can withstand repeated cleaning. Silicone pessaries generally have a maximum lifespan of between one to five years, with many providers recommending replacement around the three-to-four-year mark.
Replacement is necessitated by signs of material degradation, such as cracks, discoloration, or a noticeable softening and loss of firmness. These changes compromise the structural integrity needed for effective support and can create rough surfaces that may irritate the vaginal tissue. Additionally, a change in the patient’s anatomy, such as a shift in the degree of prolapse, may require a different size or style of pessary to maintain proper fit and symptom control.
Essential Practices for Continuous Use
Safe and continuous long-term use requires both regular medical supervision and consistent patient self-care. For patients who cannot remove and clean the device themselves, a healthcare provider must perform this service, typically scheduling follow-up appointments every three to six months. During these visits, the pessary is removed, cleaned thoroughly, and the vaginal walls are inspected for any signs of irritation or tissue damage.
Patients who manage the device themselves are instructed to remove, clean, and reinsert the pessary as often as daily or weekly. The pessary should be washed with mild soap and warm water, dried fully, and reinserted using a water-based lubricant. The use of a topical vaginal estrogen cream, particularly in postmenopausal women, is often recommended to maintain the health and thickness of the vaginal tissue, providing a protective barrier against pressure.
Recognizing Complications from Extended Wear
The prolonged presence of any foreign object in the vagina can lead to specific complications. The most frequently reported long-term issue is vaginal erosion, a superficial breakdown of the vaginal lining caused by localized pressure from the pessary. This may present as abnormal vaginal bleeding, spotting, or a new feeling of discomfort.
Other common indicators of a problem include a persistent, foul-smelling discharge or an increase in volume that does not resolve with cleaning. While minor discharge is common, a change in odor or color can signal a shift in the vaginal environment requiring medical assessment. These issues are generally manageable if identified early during routine check-ups, emphasizing adherence to the recommended follow-up schedule.