Pelvic organ prolapse is commonly treated with intravaginal devices to support the pelvic organs and maintain comfort. Pessaries generally require regular maintenance with removal, cleaning, and replacement. For women with severe dementia, this process can be extremely distressing. We present an illustrative case of a woman in whom the progression of her dementia led to a challenging ethical dilemma about continuing the use of a pessary and call for a conversation about these issues in the urogynaecology community.