A pessary is a removable medical device, typically made of silicone, that is inserted into the vagina to provide structural support to the pelvic organs. This non-surgical treatment is primarily used to manage the symptoms associated with pelvic organ prolapse, where organs like the bladder or uterus descend from their normal position. Pessaries are also frequently used to manage stress urinary incontinence, offering support to the urethra and bladder neck to prevent accidental urine leakage. While pessaries are generally safe and effective, their continuous use can lead to certain expected physiological changes.
Understanding the Primary Side Effect
The most frequently encountered side effect of pessary use is an increase in vaginal discharge, often described as thin, watery, or mucoid. This is considered a benign, physiologic response to the device’s presence, which can alter the vagina’s natural environment. The foreign object stimulates the vaginal mucosa to produce more secretions. While this increased discharge is usually not indicative of a serious problem, it can sometimes be accompanied by a mild odor or localized vaginal irritation.
A more specific and frequently reported complication arising from this constant irritation is superficial vaginal mucosal erosion. This involves a minor, localized breakdown of the outermost layer of the vaginal wall tissue where the pessary exerts pressure. These erosions are generally asymptomatic and are typically only discovered during a routine clinical examination. If an erosion is left unaddressed, the irritated area can become a site for bacterial colonization, leading to a foul odor or a change in the discharge to a purulent consistency. This mild tissue damage is almost always reversible and heals quickly once the pessary is removed temporarily.
Minimizing Risk Through Proper Care
Proactive management is highly effective in mitigating the common side effects of increased discharge and mucosal irritation. For patients who can self-manage, regular removal, cleaning, and reinsertion of the device is a simple step. This generally involves cleaning the pessary with mild soap and water on a weekly basis to remove accumulated secretions and maintain hygiene. If the patient cannot remove the pessary themselves, scheduled provider visits are necessary, typically every one to three months, for professional cleaning and examination.
The health of the vaginal tissue is supported by the application of topical estrogen creams, especially in postmenopausal women who often have thinner, more fragile mucosa. Estrogen helps to thicken the vaginal walls, improving tissue elasticity and blood flow, making the tissue more resilient to the pressure exerted by the pessary. This application can reduce the incidence of irritation-related erosions and certain vaginal infections, such as bacterial vaginosis. Proper initial fitting of the device is also paramount; an ill-fitting pessary will exert excessive pressure, making irritation and erosion far more likely.
Recognizing Signs of Serious Issues
While minor side effects are common, patients should be aware of specific signs that indicate a potentially more serious issue requiring immediate medical attention. Unexplained vaginal bleeding, especially if not related to a menstrual cycle, can signal deeper tissue damage than a superficial erosion. Severe vaginal ulceration (deeper tissue destruction) and an inability to remove the device due to it becoming stuck or embedded (pessary impaction) are serious but uncommon complications usually linked to prolonged neglect.
A significant change in discharge to a dark, bloody, or distinctly foul-smelling, purulent fluid, particularly when combined with pelvic pain or fever, may indicate a severe infection. The most serious, though extremely rare, complication is the development of a fistula, an abnormal connection between the vagina and a neighboring organ, such as the bladder (vesicovaginal fistula) or the rectum (rectovaginal fistula). Symptoms include the passage of urine or feces from the vagina. These issues are almost exclusively seen in cases where a pessary has been left in place, unmanaged, for many years. Any sudden, severe pain or the feeling that the pessary is falling out or causing intense discomfort should prompt an urgent consultation with a healthcare provider.