Management of Pessaries During and After Pap Smear
For women with pessaries, the device should be removed prior to obtaining a Pap smear and can be reinserted immediately after the procedure if no complications are present. 1
Before the Pap Smear
- Remove the pessary before performing the Pap smear to ensure proper visualization of the cervix and adequate specimen collection 1
- Document the type and size of pessary being used to ensure proper replacement 2
- Inspect the pessary for signs of deterioration, embedded tissue, or abnormal discharge when removing it 3
During the Pap Smear
- After removing the pessary, perform the Pap smear following standard collection techniques 1
- For optimal specimen collection, use a combination of Cytobrush for the endocervix and spatula for the ectocervix, which provides superior quality samples 4
- Carefully remove any discharge with a saline-soaked cotton swab before obtaining the specimen if a mucopurulent discharge is present 1
- Collect the Pap smear specimen before obtaining samples for other tests such as STI screening 1
After the Pap Smear
- Reinsert the pessary immediately after the Pap smear if no complications are observed 2
- If the pessary shows signs of deterioration, consider replacing it with a new one of the same type and size 3
- If significant vaginal inflammation or infection is detected during the examination, consider treating the condition before reinserting the pessary 1, 3
- Schedule follow-up for pessary care according to the patient's established maintenance schedule (typically every 3-6 months) 2
Special Considerations
- Women using pessaries may benefit from continued Pap smear screening even after the age when screening would typically be discontinued, as pessary use has been anecdotally associated with development of cervicovaginal cancers 1
- If the Pap smear shows severe inflammation with reactive cellular changes, advise the patient to have another Pap smear within 3 months 1
- For women with abnormal Pap results (SIL or ASCUS), ensure appropriate follow-up with colposcopy if indicated, which may require temporary removal of the pessary 1
- Consider using vaginal estrogen in postmenopausal women with pessaries to reduce complications such as vaginal irritation and discharge 5
Common Pitfalls and Caveats
- Failure to remove the pessary before the Pap smear may result in inadequate sampling and false-negative results 1, 4
- Approximately 15-20% of women using pessaries experience increased vaginal discharge that may require medical evaluation to exclude infection 1, 3
- Some women may experience difficulty with pessary reinsertion after removal; be prepared to try different sizes or types if the original pessary cannot be comfortably reinserted 6
- Long-term pessary users should be monitored for complications such as vaginal erosion or embedding of the pessary in the vaginal epithelium 3
- Patients should be educated about signs of complications requiring medical attention, including unusual discharge, bleeding, or pain 5