An 82-year-old unfit woman with stage III uterovaginal prolapse is managed conservatively with a ring pessary. She returns for routine review. What is the most important complication to screen for during long-term pessary use?

• A Acute urinary retention
• B Malignant transformation of the cervix
• C Vaginal mucosal erosion and pressure ulceration ✓
• D Rectovaginal fistula

Explanation

C pessary left unchanged presses against the vaginal walls, causing pressure necrosis, erosions, ulceration, discharge, bleeding, and rarely fistula formation, so it must be removed, cleaned, and reinserted every 8 to 12 weeks with inspection of the vagina at each visit. Cervical cancer risk is not increased by a pessary, and retention or fistula are rare late events rather than routine screening targets.

Reference: DC Dutta's Textbook of Gynecology, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.