Pelvic organ prolapse (POP) is common among aging women. Up to 50% have some degree of POP, while six to eight percent experience symptoms. With an aging population, the prevalence of POP is expected to increase, leading to additional demands on already strained healthcare systems. 
Pessary treatment is a cost-effective treatment for POP, but is often discontinued because of side effects such as vaginal discharge, vaginal blood loss due to decubitus, discomfort, and intercourse related problems [1].
Traditional clinical management (CM) which involves regular removal, cleaning, and reinsertion of the pessary by a healthcare professional, burdens healthcare services and may be inconvenient for patients [2].
Therefore, interest in pessary self-management (PSM), in which patients manage their pessary independently has increased. PSM may improve healthcare sustainability and patient autonomy and satisfaction [3].
The aim of this study was to investigate whether PSM is superior to CM regarding side effects after 12 months of pessary treatment We also evaluated treatment continuation, crossover to surgery, and number of consultations in the first year after treatment initiation.

A prospective cohort study was conducted in seven Dutch medical centres between 2023 and 2025. Patients with POP for whom a PSM-suitable pessary (ring, ring with knob, ring with support) was fitted were included. Cube pessaries were excluded as they are PSM-only. All patients were offered PSM training by a specialist nurse. Data on patient characteristics were obtained from the electronic health record. Patients received questionnaires at baseline, six weeks and 12 months after treatment initiation. Questionnaires contained disease-specific questions, side effects (e.g. vaginal discharge, decubitus related blood loss, pain/discomfort, intercourse difficulties), and treatment continuation. Independent samples t-tests, chi-square tests, and logistic regression analyses were performed to compare groups and identify factors associated with treatment continuation.

Of 301 included patients, 249 opted for PSM of whom 208 (84%) successfully learned self-management. Women in the PSM group were younger (61 vs. 69 p <0.001) and had a lower BMI (24.6 vs. 25.9 p = 0.01) compared with the women in de CM group.
At 12 months, there was no difference in side effects between the groups, treatment continuation was high and crossover to surgery was low in both groups. The number of physician consultations was significantly lower in the PSM group compared with the CM group (Table 1).
In the PSM group pain/discomfort was associated with discontinuation of treatment (Table 2). In the CM group, vaginal discharge and intercourse difficulties were associated with discontinuation in both univariable and multivariable analyses (Table 2).

PSM is a feasible and comparable alternative to CM. Although no difference in side effects was observed between the groups, the CM group required a higher number of physician consultations than the PSM group, a finding with important implications for reducing the burden on healthcare services.
Intercourse related problems and vaginal discharge were associated with treatment discontinuation in the CM group. These associations were not observed in the PSM group. This may be explained by the ability of women in the PSM group to temporarily remove the pessary when experiencing discharge or intercourse difficulties.

PSM had an 83% success rate among those willing to learn. Side effects, treatment continuation, and crossover to surgery were similar between groups, but the number of physician consultations was significantly lower in the PSM group. Pain/discomfort was associated with discontinuation in the PSM group, whereas vaginal discharge and intercourse difficulties did so in the CM group.

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Continence 19S (2026) 102486
DOI: 10.1016/j.cont.2026.102486