A pessary is a medical device, typically made of soft silicone, that is inserted into the vagina to provide physical support for the pelvic organs. This non-surgical treatment option is commonly used to manage symptoms of pelvic organ prolapse or stress urinary incontinence. Proper maintenance, including routine removal and cleaning, is necessary to prevent complications and maintain the device’s efficacy. The specific frequency for this self-care is highly individualized and determined by the prescribing healthcare provider based on the patient’s needs and the type of device used.
Varying Schedules for Pessary Management
The frequency of pessary removal and cleaning depends on the patient’s ability to manage the device independently and the specific shape of the pessary. Management schedules fall into two main categories: self-management or clinician-management. Patients who are comfortable and physically capable of removing, cleaning, and reinserting the device themselves typically adhere to a daily or weekly schedule.
Many common ring or folding pessaries are designed for self-management, often requiring removal once a week for cleaning. Some patients remove these devices nightly, cleaning them and leaving them out while they sleep, then reinserting them the following morning. However, certain types, such as the cube pessary, must be removed and cleaned nightly because their concave surfaces create suction, which can lead to tissue damage if left in place for extended periods.
For patients unable or unwilling to manage their device, removal and cleaning are performed by a clinician during an office visit. This often applies to larger or more complex space-filling devices like the Gellhorn or Shaatz pessary, which are difficult for a patient to manipulate. For clinician-managed devices, the recommended interval for removal, cleaning, and vaginal check-up is usually every one to three months, sometimes extended to six months if the patient is using vaginal estrogen therapy.
Essential Steps for Cleaning and Reinsertion
Pessary maintenance requires careful attention to hygiene and detail to protect both the device and the vaginal tissues. Thoroughly wash your hands with soap and water before touching the pessary for removal. When removing the device, use a gentle technique, sometimes requiring the user to break any suction or fold the device slightly as it is withdrawn.
Once removed, clean the pessary using warm water and a mild, unscented soap. Avoid using harsh chemicals, strongly scented soaps, or boiling the device, as these can irritate vaginal tissue or degrade the silicone. After washing, the pessary must be rinsed completely to ensure no soap residue remains, and then dried thoroughly before reinsertion.
Before reinsertion, inspect the device for signs of damage, such as cracks, rough edges, or a loss of flexibility. Applying a small amount of water-based lubricant minimizes friction against the vaginal walls and makes reinsertion easier. While technique varies, many find it easiest to stand with one foot propped on a surface or to lie down to relax the pelvic muscles.
Recognizing and Preventing Complications
Neglecting the prescribed maintenance schedule can lead to adverse health consequences. A common issue is increased vaginal discharge, which may become foul-smelling if the device is not cleaned often enough, potentially indicating an infection like bacterial vaginosis. Other immediate warning signs requiring medical attention include new or unusual vaginal bleeding, persistent pelvic pain, or difficulty with urination or bowel movements.
A more serious complication from infrequent removal is vaginal wall erosion, where constant pressure causes tissue breakdown and the formation of ulcers. Consistent removal allows the vaginal tissue to rest and be inspected, preventing these pressure injuries. Using a vaginal moisturizer or prescribed vaginal estrogen cream can help maintain the thickness and health of the vaginal lining, reducing the risk of friction and irritation.
Adhering strictly to the provider’s schedule is the primary prevention strategy against complications. Using a water-based lubricant during reinsertion is necessary to reduce friction and irritation. Regular follow-up appointments, even for self-managing patients, are necessary for the clinician to examine the vaginal walls for early signs of erosion and to ensure the pessary still fits correctly.