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Side effects

First time users of pessaries may be surprised to find that there is at least one common side effect of pessary use. Some women aren’t bothered by it at all yet others find this side effect so bothersome that they discontinue pessary use altogether. It is good to be aware of the following potential side effect when considering if pessary use is for you.

• Increased vaginal secretions
  • This is the body’s natural reaction to there being a foreign object in the vagina. It is a protective response in order to provide extra lubrication to minimize friction between the pessary and the vaginal tissues. Additionally, if you leave your pessary in for a few days (only speaking about those with drainage holes that are safe to be left in for a few days), you may experience a build up of discharge when you remove your pessary; this is normal. Signs of abnormal discharge to be aware of are listed below.

Risks

A pessary is very safe when users follow the instructions for care and management. However, there are certain risks associated with the use of a pessary. In case of an emergency and you are unable to advise doctors that you wear a pessary, it is a good idea to tell a close friend or carry a note in your wallet declaring that you wear a pessary. The most common risks are denoted with an * below.

• Irritation/fissure at the introitus*
  • The entrance of the vagina can become irritated to the point of tiny tears in the skin from repeated removal and insertion of the pessary. This is most likely to occur in the post-partum stage or in post-menopausal women, in both scenarios due to a lack of estrogen which helps to keep our tissues flexible and elastic. This can be rectified with the use of a topical estrogen or even vaginal moisturizer. If this occurs, stop pessary use, see your doctor and follow the treatment plan before resuming pessary use.
• Vaginal infection as evidenced by yellow/green discharge and/or an offensive odour*
  • It is imperative that you clean your pessary thoroughly, as prescribed, rinse it impeccably after cleaning it, store it in a clean, dry place when you are not wearing it, and always wash your hands thoroughly before inserting or removing it. These precautionary measures help to ensure you avoid vaginal infections. If you notice yellow, green or foul-smelling discharge, remove the pessary and see your doctor. Ensure the infection has cleared fully before starting to use your pessary again.
• Small amount of blood on pessary*
  • The pessary can rub on the tissues inside your vagina, irritating them and eventually causing small lesions. If you notice pinkish-tinged discharge on your pessary when you remove it, keep it out and see your doctor. Your doctor will do a gynecological exam to assess your vaginal tissues. He or she might suggest a vaginal estrogen to improve the integrity of your tissues; this can help increase blood flow and increase the thickness, and therefore resilience, of the tissue. After the tissues have healed sufficiently, you will be able to resume use of your pessary.
• Expulsion of the pessary with bearing down (heavy lifting or straining for a bowel movement)
  • If you bear down greatly (as if attempting to pass large, hard stool), a pessary can fall out. However, this should not happen on a regular basis, even with heavy lifting or having a bowel movement. If it does, contact your physiotherapist as you may require a different size or shape of pessary.
• Stress urinary incontinence
  • Sometimes the use of a pessary will unmask pre-existing stress urinary incontinence (SUI). SUI is the leakage of urine with activity, for example with coughing, laughing, sneezing, standing up from a chair, jumping, or running. This can happen because when your bladder hangs lower than it is supposed to, it can kink the urethra (the tube that drains the bladder of urine). This kink helps to prevent unwanted urinary leakage. However, an inserted pessary holds the bladder in its proper position, thereby unkinking the urethra and allowing urine to leak more easily. If this is your experience, ask to trial pessaries made specifically for SUI as well as POP. Your physiotherapist may also suggest pelvic floor muscle training to reduce/eliminate your stress urinary incontinence.
• Irritation or ulcers with or without bleeding of the vaginal tissues
  • Pressure from the pessary on your vaginal tissues can lead to irritation and eventual breakdown of tissues leading to the formation of ulcers. If you feel any pain with pessary use, see your doctor. He/she will conduct a gynecological exam to inspect the state of your vaginal walls, looking for signs of irritation or skin breakdown. If this is the case, you might be prescribed a topical estrogen to help your body increase the strength and health of your tissues (increased blood flow and extensibility of tissues, decreased fragility). You will be directed to not use your pessary until your tissues have healed.
• Difficulty/pain evacuating bowels or emptying bladder
  • A pessary should not negatively affect your ability to void your bladder or evacuate your bowels. If this is your experience, see your physiotherapist or fitting health care professional as a different size or shape may be warranted.
• Urinary tract infection
  • See “vaginal infection” above for tips to minimize your chance of infection with pessary use. If you experience burning with urination and/or increased frequency and urgency of urination, see your doctor to rule out the possibility of a urinary tract infection.
• Incarceration
  • Very rare: In cases where a pessary is forgotten or mismanaged and left in place for far longer than advised (years) without removal, the pessary can become stuck in the vaginal tissue. In this case, it needs to be surgically removed. This is why it is imperative to follow your recommended treatment plan and let someone close to you know that you wear a pessary.
• Fistula
  • Very rare: When the pessary wears the tissue down, creating a hole between two organs, for example between the vagina and bladder or the vagina and rectum. One hallmark symptom of a fistula is leaking bladder or bowel contents from the vagina. This is a serious medical condition requiring surgical repair.
• Migration
  • Very rare: This occurs when the pessary moves from one organ to another (vagina to bladder or rectum). This is a serious medical condition requiring surgical removal and repair.
• Increased risk of squamous cell vaginal cancer
  • There has been one documented case where the use of a pessary is believed to have led to squamous cell vaginal cancer. This was with prolonged use and inadequate supervision. Again, it is imperative to regularly follow-up with your physician every 6-12 months (or at an interval suggested by your physician) for a gynecological exam to ensure ongoing tissue health.

If you experience any symptoms associated with these potential risks, notify your physiotherapist and see your doctor. An exam will be conducted to ensure your tissues are healthy and that you can continue safe pessary use. Read our blog entitled “When to Seek Medical Attention” for more information about warning signs indicating when a visit to the doctor is needed.

The information in this blog is provided as an information resource only and should not be used as a substitute for seeking personalized direction from your overseeing physician. Please consult your healthcare team before making any decisions about your pessary treatment plan, which is unique to you and your overall health. Toronto Pessary Clinic expressly disclaims responsibility, and shall have no liability, for any damages, loss, injury, or liability whatsoever suffered as a result of your reliance on the information contained in this blog.