Benign gynaecology: ring pessary complication: practice question

A OBG question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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OBG · Benign gynaecology: ring pessary complication

Sample item

A 78-year-old woman using a ring pessary for stage III prolapse for 2 years presents with blood-stained foul vaginal discharge. Speculum examination shows an ulcer on the vaginal wall where the pessary sits. What is the best management?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Remove the pessary, treat with topical oestrogen and review before re-fitting

Pressure ulceration and discharge are common with neglected pessaries, and atrophic mucosa predisposes to it. The pessary is removed, topical oestrogen aids healing, and a new fitting follows once the ulcer has healed, with regular changes. Biopsy is considered if the ulcer looks suspicious or fails to heal.

Option by option

  • A. Leave the pessary and add oral antibiotics only

    Leaving the pessary in place continues the pressure that caused the ulcer.

  • B. Insert a larger pessary to bridge the ulcer

    A larger device will increase pressure and worsen erosion.

  • C. Immediate radical vaginectomy

    Radical surgery is not indicated for a pressure ulcer.

  • D. Remove the pessary, treat with topical oestrogen and review before re-fitting (correct)

    Correct. Removal with local oestrogen allows healing before re-fitting.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this OBG question

What is the answer to this OBG question?

The best answer is D, Remove the pessary, treat with topical oestrogen and review before re-fitting. Pressure ulceration and discharge are common with neglected pessaries, and atrophic mucosa predisposes to it.

Why is "Leave the pessary and add oral antibiotics only" not the answer?

Leaving the pessary in place continues the pressure that caused the ulcer.

Why is "Insert a larger pessary to bridge the ulcer" not the answer?

A larger device will increase pressure and worsen erosion.

Why is "Immediate radical vaginectomy" not the answer?

Radical surgery is not indicated for a pressure ulcer.

What concept does this question test?

It tests Benign gynaecology: ring pessary complication in OBG. The pessary is removed, topical oestrogen aids healing, and a new fitting follows once the ulcer has healed, with regular changes. Biopsy is considered if the ulcer looks suspicious or fails to heal.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Benign gynaecology: ring pessary complication?

Learn management algorithms as steps: PPH, eclampsia, ectopic pregnancy. Then use the flashcards and the other OBG questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.