Why Do You Have Brown Discharge With a Pessary?

Brown discharge in someone wearing a vaginal pessary almost always comes from minor irritation or small erosions on the vaginal wall, where a tiny amount of blood mixes with normal vaginal fluid and turns brown by the time it reaches underwear. Vaginal discharge, including discolored discharge, is one of the three most frequently reported pessary side effects alongside odor and erosion. The color itself is usually a sign that the bleeding is slow and old rather than fresh, which sounds reassuring on its own but still deserves attention because the causes range from harmless friction to tissue changes worth treating.

Why Pessaries Cause Discharge in the First Place

A pessary sits inside the vagina, pressing against the vaginal walls to support prolapsed organs. That constant contact creates friction, and the body responds to the foreign object with increased vaginal secretions. Research tracking women prospectively after pessary fitting found that about 30% of pessary users reported bothersome discharge, compared to roughly 2% of women not using a pessary, and that these changes developed during the first two weeks of use.¹ So if you notice more discharge shortly after getting a pessary, that timeline is typical.

Discharge that is white or clear is usually just the body’s response to the device. When discharge turns brown, it usually means small amounts of blood are mixing in. The vaginal lining can develop tiny areas of wear, sometimes called erosions, where the pessary rubs. These are not deep wounds but superficial spots where the top layer of tissue breaks down. Blood from these spots is often minimal and slow, so it oxidizes before leaving the body, producing the brownish color rather than bright red.

Erosion and Why It Happens

Vaginal erosion is the most direct explanation for brown discharge. A comprehensive review of pessary complications found that vaginal discharge, erosion, and bleeding were the three most commonly reported issues across 61 studies.² Erosions are shallow abrasions on the vaginal wall where the pessary presses. They bleed a small amount, which mixes with vaginal fluid, and the result is often brownish or blood-tinged discharge rather than frank bleeding.

Not all pessary types carry the same risk. A study tracking adverse events over a year found that Gellhorn and donut-shaped pessaries were more than twice as likely to cause erosions compared to ring-with-support pessaries or incontinence rings.³ The reason is partly mechanical: Gellhorn pessaries have a rigid stem and a broad disc that concentrates pressure on a smaller area of the vaginal wall. Ring pessaries distribute force more evenly, so they tend to be gentler on tissue. If you are experiencing persistent brown discharge and you wear a Gellhorn or donut pessary, it is worth asking your provider whether a ring-style device might reduce the irritation.

The Role of Vaginal Atrophy

Many women who use pessaries are postmenopausal, and lower estrogen levels after menopause cause the vaginal lining to become thinner, drier, and more fragile. This thinning, called vaginal atrophy, makes the tissue much more vulnerable to erosion from a pessary. Think of it as the difference between rubbing a device against thick, well-moisturized skin versus thin, dry tissue. The thinner tissue breaks down more easily.

Research has confirmed this connection. A study comparing outcomes in women using different pessary types found that those not using vaginal estrogen had a higher risk of vaginal ulceration, bleeding, and discharge, particularly with non-ring pessary designs.⁴ Atrophy makes the vaginal wall more susceptible to the very complications that produce brown discharge, so addressing it is often a key part of managing symptoms.

Is It an Infection?

A natural worry when you see brown or discolored discharge is that something infectious is going on. Pessaries do change the vaginal environment, and the same study that tracked discharge rates found that pessary users showed more microscopic evidence of vaginal inflammation.⁵ However, and this is an important distinction, the bacteria found in women with bothersome discharge were nearly identical to those found in pessary users without bothersome discharge. In other words, the discharge appears to be driven by the physical presence of the device and the body’s inflammatory response, not by bacterial overgrowth or infection.

A cross-sectional study looking at bacterial vaginosis rates in pessary users found that while the condition was somewhat more common in pessary users than in controls, the difference was not statistically significant.⁶ This does not mean infection never happens, but it does mean that brown discharge alone is not reliable evidence of one. If the discharge has a strong, foul odor, is accompanied by itching or burning, or comes with fever, those are the signals more suggestive of infection. Brown color by itself points more toward mechanical irritation or erosion.

Can Vaginal Estrogen Help?

Because vaginal atrophy plays such a large role in pessary-related erosion and bleeding, the logical question is whether treating the atrophy with topical estrogen reduces these complications. The answer from research is mixed but increasingly positive, especially from newer and larger trials.

A large multicenter randomized trial published in the BMJ found that women assigned to intravaginal conjugated estrogen had lower rates of excessive discharge, vaginal erosion, and vaginal bleeding compared to the placebo group. Excessive discharge occurred in about 16% of the estrogen group versus roughly 26% of the placebo group. Vaginal erosions or ulcers dropped from about 7% to about 2%, and vaginal bleeding dropped from about 6% to under 2%.⁷ Those are meaningful reductions across the board.

Earlier, smaller studies were less conclusive. One study found that median time to erosion did not differ between estrogen users and non-users.⁸ Another randomized trial found no significant difference in erosion rates between groups after six months, with erosion occurring in about 10% of the control group.⁹ Why the discrepancy? The BMJ trial was substantially larger and used a different estrogen formulation. The overall trajectory of the evidence is leaning toward benefit, particularly for reducing the kinds of tissue breakdown that lead to brown discharge. If you are postmenopausal and dealing with recurrent brown or blood-tinged discharge from your pessary, asking your provider about vaginal estrogen is a reasonable step.

Cleaning, Follow-Up, and Self-Management

Some women assume that if they could just clean the pessary more aggressively, the discharge would stop. The evidence suggests that cleaning matters for overall hygiene, but it may not dramatically change discharge levels on its own. A prospective study found no significant differences in pain, discharge, or irritation scores before and after pessary cleaning visits, whether the women managed the pessary themselves at home or had it done in clinic.¹⁰ This makes sense once you understand that the discharge is primarily a tissue-level response to the device, not a cleanliness issue.

That said, regular follow-up remains important. Clinical guidelines note that minor complications like discharge, odor, and erosions are usually treatable, but major complications have been reported when pessaries are neglected for long periods without any clinical check.¹¹ There is a meaningful difference between a pessary that is checked every few months and one that stays in place for years without a visit.

Self-management, where you remove, clean, and reinsert the pessary at home, gives you the advantage of regular inspection. You can look for visible erosions, check for blood on the device, and notice changes in discharge between clinic visits. Ring pessaries are generally the easiest to self-manage because of their flexible shape. If you are not currently self-managing, it is worth discussing with your provider, especially if you are bothered by discharge and want to monitor it more closely.

When Brown Discharge Needs Urgent Attention

Brown discharge on its own, while worth mentioning to your provider, is rarely dangerous. The threshold for concern rises when discharge is accompanied by certain other signs:

Bright red bleeding: Active, fresh bleeding suggests a deeper erosion or ulceration rather than a superficial one.
Foul odor: A strong smell, especially fishy or rotten, may point toward infection or trapped tissue debris, particularly if the pessary has not been removed in a long time.
Pain or pressure change: If the pessary suddenly feels different, is causing new pain, or if you sense it has shifted, it may be pressing into tissue in a way that needs correction.
Urinary symptoms: New difficulty urinating, blood in urine, or recurrent urinary infections can signal that the pessary has eroded into nearby structures.

Severe complications from pessaries are rare but well-documented when devices go unchecked for years. A systematic review of case reports of rare pessary complications found that the most frequent serious outcomes were fistulas, which are abnormal connections between the vagina and the bladder or rectum, along with vaginal impaction of the device. The median age in these cases was 82 years, and the common thread was prolonged neglect.¹² A case report described an 89-year-old woman whose Gellhorn pessary had been neglected for three years, resulting in the device migrating into the bladder and creating a large fistula.¹³ These cases are extreme and preventable with routine follow-up, but they illustrate why ongoing monitoring matters.

The Emotional Side of Pessary Discharge

What the clinical literature sometimes underplays is how distressing discharge can be on a daily basis. Stained underwear, worry about odor, and uncertainty about whether something is seriously wrong all take a psychological toll. Qualitative research on women’s experiences with pelvic organ prolapse treatment found that fear, shame, and miscommunication were major themes, with women often delaying care or avoiding conversations about their symptoms because of societal taboos around these issues.¹⁴

Brown discharge, specifically, triggers anxiety because people associate it with blood and therefore with something being wrong inside. The reality for most pessary users is far less dramatic. But if you feel embarrassed bringing it up at appointments, know that this is one of the most common pessary-related complaints clinicians encounter. It is not a small or silly concern, and it is exactly the kind of thing that should be discussed so your provider can check the tissue, adjust the device if needed, and consider treatments like vaginal estrogen.

Pessary Types and How They Affect Discharge

If you have been fitted with a pessary and are dealing with recurrent brown discharge, the specific type of device you are using matters. Pessaries have been used for pelvic organ prolapse since antiquity, with materials evolving from linen and cork to rubber and eventually to the medical-grade silicone used today.¹⁵ Modern silicone is non-reactive and smooth, which reduces but does not eliminate tissue irritation.

Among current designs, the key distinction is between support pessaries and space-filling pessaries. Ring pessaries (with or without a support membrane) are the most commonly prescribed support type. They sit around the cervix or vaginal cuff and hold tissue up without filling the vaginal canal. Gellhorn pessaries and donut pessaries are space-filling devices that occupy more of the vaginal canal and exert more localized pressure. As noted earlier, the space-filling types are associated with roughly double the rate of erosion compared to ring-style devices.¹⁶ If your prolapse is mild enough that a ring pessary can manage it, switching from a Gellhorn or donut may reduce the erosions driving your brown discharge.

Sizing also plays a role, though this is harder to study systematically. A pessary that is too large puts excessive pressure on the vaginal walls, while one that is too small may shift and rub unevenly. Getting the right fit often requires trying more than one size, and your anatomy can change over time, especially if you lose or gain weight. If brown discharge appears suddenly after years of comfortable pessary use, a re-fitting appointment is a practical first step.

What Brown Discharge Is Not

It is worth clarifying what brown discharge from a pessary does not indicate, because worry sometimes sends people to the wrong conclusion. Brown pessary discharge is not a sign of cancer by itself. While cancer was listed among the most severe pessary complications in a classification review, those cases involved long-neglected devices and chronic untreated erosion, not the ordinary discharge most users experience.¹⁷ A pessary fitting does not increase your baseline cancer risk. It can, however, create erosions that look alarming on examination, so your provider may want to take a closer look at any persistent sore spot to rule out other causes, particularly in older women.

Brown discharge is also not necessarily a sign that the pessary is failing to manage your prolapse. Discharge and prolapse support are largely separate issues. You can have excellent prolapse control with a well-fitted pessary and still deal with brown discharge from a small erosion. The two problems have different solutions: one involves device fit and positioning, the other involves tissue health and sometimes topical estrogen.

Finally, brown discharge does not automatically mean you need surgery instead. Clinical guidelines emphasize that these minor complications are usually manageable with conservative measures.¹⁸ Surgery for pelvic organ prolapse is a valid option for women who want it, but persistent discharge alone is not a standard indication for an operation. The conversation should be about what is bothering you and whether conservative adjustments have been exhausted, not about interpreting brown discharge as a sign that pessary therapy has failed.