Ring Pessary vs Gellhorn Pessary: 2026 Clinical Comparison
Ring Pessary vs Gellhorn Pessary: 2026 Clinical Comparison
Ring and Gellhorn are the two most-fitted pessary types in US clinical practice. They treat different stages and types of pelvic organ prolapse. Here is the honest comparison so you can understand which your provider will likely fit — and why.
If your gynecologist has mentioned either a ring pessary or a Gellhorn pessary, you're comparing the two most common pessary types in US clinical practice. According to Cooley & Jones in Canadian Family Physician (PMC1949074), ring pessaries treat approximately 80% of grade 1 and 2 prolapse cases — while Gellhorn pessaries are typically reserved for more advanced or grade 3–4 prolapse where a ring will not stay in place.
Quick comparison: Ring vs Gellhorn Pessary
| Feature | Ring Pessary | Gellhorn Pessary |
|---|---|---|
| Prolapse stage treated | Grade 1–2 (early-mid) | Grade 3–4 (advanced) |
| Category | Support pessary | Space-filling pessary |
| Shape | Open ring, folds for insertion | Disc-and-stem, does not fold |
| Fit % of women | ~70% (per IUGA) | Reserved for advanced cases |
| Self-management | Yes — patient can remove/reinsert | Difficult — typically provider-managed |
| Can be worn during intercourse | Ring without support: yes | No |
| Insertion method | Fold in half, insert, release behind pubic bone | Provider inserts, patient does not remove daily |
| Cleaning frequency | Weekly self-clean | Every 2–3 months at provider visit |
| Follow-up frequency | Every 3–6 months | Every 2–3 months |
| Comfort during activities | Well tolerated for daily wear | May cause pressure at first |
| SciMed availability | Yes — $49.99 with support / $44.99 without | Not currently stocked |
What is a Ring Pessary?
A ring pessary is a round silicone device that sits in the vaginal fornix (upper vagina) and provides support against pelvic organ descent. It is the most commonly used pessary type worldwide because it fits the majority of women, is easy to self-manage, and works well for early-to-mid stage prolapse. Ring pessaries come in two varieties:
- Ring with Support: Has a thin silicone membrane across the ring, providing additional bladder neck support. Preferred for patients with concurrent cystocele or mild stress urinary incontinence.
- Ring without Support: Open ring design. Preferred for prolapse without cystocele; can typically be worn during intercourse.
Both types are used for Stage I–II prolapse and are patient-managed — you can remove, clean, and reinsert the device yourself between clinical visits. Learn more in our Ring Pessary Size Guide.
What is a Gellhorn Pessary?
A Gellhorn pessary is a space-filling pessary shaped like a disc with a short central stem. The disc sits at the top of the vagina (against the cervix or vaginal cuff), and the stem points outward toward the introitus. It creates a mechanical barrier that prevents the pelvic organs from descending further.
According to the University of Colorado Anschutz urogynecology team, Gellhorn pessaries are "primarily used to support severe pelvic organ prolapse, especially when the vagina drops after hysterectomy." They are typically fitted by a provider and left in place for weeks to months at a time, with clinical cleaning at follow-up visits every 2–3 months.
Which one will my provider fit?
Ring Pessary is typically fitted when:
- Prolapse is Stage I–II (bulge stays within or at the hymen)
- You want to self-manage the device
- You want to be able to remove for intercourse (ring without support)
- You have coexisting cystocele or mild stress incontinence (ring with support)
- You are bridging pre- or post-surgical repair
- You want a device you can easily learn to insert at home
Gellhorn Pessary is typically fitted when:
- Prolapse is Stage III–IV (bulge extends past the hymen)
- A ring pessary was tried and fell out
- You have post-hysterectomy vaginal vault prolapse
- You are unable or unwilling to self-manage the device
- Your provider needs the mechanical support of a space-filling design
Fitting process: how each is trialed
Ring Pessary fitting
- Provider performs pelvic exam to assess prolapse stage and vaginal vault depth
- Trial ring pessary inserted (most patients fit 3–5, or 64–76mm)
- You stand, walk, cough, and bear down to test retention
- You demonstrate ability to remove and reinsert the device
- You go home with a properly-fitted device — wear it daily, clean weekly
Gellhorn Pessary fitting
- Provider performs pelvic exam to assess vault depth and prolapse severity
- Trial Gellhorn inserted (sizes typically 1.5–35″ diameter)
- Retention verified with cough test and standing evaluation
- Device left in place; patient returns at 2–4 weeks for first check
- Ongoing clinical management every 2–3 months
Cost comparison
| Cost category | Ring Pessary | Gellhorn Pessary |
|---|---|---|
| Device cost (retail) | $44.99–$99.99 (direct manufacturer) | $120–$250 (via clinical distributor) |
| Clinical fitting visit | $100–$300 (initial only, if any) | $100–$300 (initial fitting) |
| Follow-up visits/year | 2–4 self-managed visits | 4–6 provider-managed visits |
| Annual maintenance cost | Minimal (device life 1–2 years) | Higher (frequent provider cleanings) |
| HSA/FSA eligible | Yes (HCPCS A4561) | Yes (HCPCS A4561) |
Can I move from Gellhorn to Ring or vice versa?
Yes, but only with clinical guidance. If prolapse improves after pelvic floor physical therapy, weight loss, or other treatment, a patient previously fitted for Gellhorn may transition to a ring pessary. Conversely, if a ring pessary starts to fall out (indicating prolapse progression), your provider may switch you to a Gellhorn or another space-filling pessary type. This transition is a clinical decision made during your regular follow-up examination.
Frequently asked questions
Is a ring pessary or Gellhorn pessary better for me?
Neither is inherently "better" — they treat different prolapse stages. Ring pessary works for grade 1–2 prolapse in the majority of patients. Gellhorn is reserved for grade 3–4 advanced prolapse or cases where a ring will not stay in place. Your gynecologist or urogynecologist will assess your prolapse stage and recommend the appropriate device.
Can I use a ring pessary if I have Stage III prolapse?
Sometimes yes, especially with a large ring size and support membrane. However, most Stage III–IV patients find that a ring pessary falls out during activity. If that happens, your provider will typically switch to a Gellhorn or another space-filling design.
Can I self-remove a Gellhorn pessary?
Most patients cannot easily self-remove a Gellhorn pessary because of the stem-and-disc shape. Gellhorn pessaries are typically provider-managed, with cleaning and repositioning done during clinical visits every 2–3 months. Some experienced patients learn to self-remove for personal cleaning.
Is a Gellhorn pessary covered by insurance?
Yes, both ring and Gellhorn pessaries are covered under HCPCS code A4561 (Pessary, rubber, any type). Most US insurance plans and Medicare Part B cover pessary devices under prosthetic/DME benefits. HSA/FSA eligibility applies to both.
Why does SciMed offer only ring pessaries and not Gellhorn?
SciMed focuses on the ring pessary line — with support and without support, sizes 0–9 — because ring is the most-used pessary type and covers the majority of prolapse patients (grades 1–2). For Gellhorn, cube, or donut pessaries needed for advanced prolapse, we recommend clinical procurement through the standard distributor channel (Milex/CooperSurgical, Bioteque, etc.).
How long does each type of pessary last?
Ring pessary: 1–2 years with proper self-cleaning. Gellhorn pessary: 2–3 years with provider-managed cleaning. Both should be replaced sooner if you notice surface degradation, discoloration, or persistent odor.
Clinical references
- Cooley LE, Jones DR. Vaginal pessaries for pelvic organ prolapse. Canadian Family Physician, 2007. PMC1949074.
- International Urogynecological Association. Expert Opinion: Vaginal Pessaries in the Management of Pelvic Organ Prolapse. IUGA Spotlight.
- University of Colorado Anschutz Urogynecology. Pessary information for patients.
- POGP UK Pessary Types Guide, April 2021. POGP.