What non‑hormonal vaginal moisturizer is recommended for pessary maintenance in a 32‑year‑old active woman with regular menses and stress urinary incontinence who uses the pessary only during teaching sessions?

Non-Hormonal Vaginal Moisturizer for Pessary Use

Use a water-based vaginal moisturizer (such as Replens or similar products) applied 2-3 times weekly for pessary maintenance, as this provides adequate lubrication without hormonal exposure in a premenopausal woman.

Rationale for Non-Hormonal Approach

In your 32-year-old premenopausal patient with regular menses, vaginal estrogen is not indicated because she does not have genitourinary syndrome of menopause (GSM). The guideline evidence specifically addresses postmenopausal women with GSM 1. Your patient has normal estrogen levels and does not require hormonal supplementation.

Specific Recommendations for Pessary Maintenance

Vaginal moisturizers are the appropriate first-line choice for several reasons:

• Moisturizers provide sustained lubrication over several days (typically applied 2-3 times weekly), which is ideal for intermittent pessary use during teaching sessions
• They adhere to vaginal tissue and maintain hydration between applications
• No hormonal exposure is necessary or appropriate in a woman with regular menstrual cycles

Lubricants can be used adjunctively at the time of pessary insertion/removal for immediate ease of placement, but they provide only temporary relief and would not be sufficient alone for maintenance.

Clinical Pitfalls to Avoid

• Do not prescribe vaginal estrogen in this premenopausal woman—she has adequate endogenous estrogen production
• Be aware that some moisturizers/lubricants may cause irritation in sensitive individuals; if this occurs, switch to a different formulation (hypoallergenic, fragrance-free options)
• Ensure proper pessary fitting and hygiene practices, as these are more critical than moisturizer choice for preventing complications

Product Selection

Choose products that are:

• Water-based or polycarbophil-based (bioadhesive)
• Fragrance-free and preservative-minimal
• pH-balanced for vaginal tissue (pH 3.5-4.5)

The evidence supports that moisturizers improve vaginal dryness and comfort 1, making them suitable for reducing friction and irritation from pessary use during her high-impact activities.