From the Guidelines
A pessary should be changed every 3 months to prevent device-related infections and other complications, as recommended by the most recent and highest quality study 1. This recommendation is based on the findings of a 2023 study published in the Ca-A Cancer Journal for Clinicians, which highlights the importance of routine replacement of devices to prevent intraluminal obstruction and reduce the risk of infections 1. The study suggests that routine replacement every 3 months or even more frequently in high-risk patients can help prevent complications such as hydronephrosis, renal failure, and bacteremia 1. Key points to consider when changing a pessary include:
- The type of pessary being used
- The individual's vaginal health and risk factors for complications
- The healthcare provider's recommendations for maintenance and follow-up Regular follow-up appointments are crucial to ensure the pessary continues to fit properly and effectively manages pelvic support needs. In addition to regular changes, it is essential to practice good self-care, including removing, cleaning, and reinserting the pessary as recommended by the healthcare provider, typically every 1 to 2 weeks for self-managed pessaries. Women should be aware of potential complications such as vaginal infections, ulcerations, or erosions and seek medical attention promptly if they experience increased vaginal discharge, odor, discomfort, or difficulty urinating.
From the Research
Pessary Change Frequency
- The frequency of pessary change is not universally agreed upon, with varying practices among clinicians 2.
- A survey of IUGA urogynaecologists found that 35% of respondents preferred to change shelf/Gellhorn pessaries every 3 months, while 31% opted for every 6 months 2.
- For ring pessaries, one study suggested that continuous use for 2-4 years is safe and effective, with replacement or removal as needed 3.
- Another study found that cleaning and monitoring ring pessaries every 6 months did not increase the risk of complications 4.
Factors Influencing Pessary Change
- The type of pessary used, such as shelf/Gellhorn or ring, may influence the frequency of change 2, 3.
- Patient factors, including age, comorbidities, and prolapse severity, may also impact pessary management 4, 5.
- Adverse events, such as vaginal discharge or foul odor, may necessitate more frequent pessary change or removal 3, 4, 5.
Clinical Considerations
- Clinicians should consider individual patient needs and circumstances when determining pessary change frequency 2, 5.
- Regular follow-up and monitoring are essential to prevent complications and ensure effective pessary use 3, 4.
- Further research is needed to establish evidence-based guidelines for pessary management, including change frequency 2, 3, 4.