Ring vs Gellhorn vs Donut Pessary — 2026 Types Guide

Pessaries come in three main shapes for pelvic organ prolapse: ring, Gellhorn, and donut. Each has a distinct clinical role. This 2026 guide covers which shape fits which patient and prolapse grade, insertion difficulty, retention characteristics, and when to escalate from ring to Gellhorn or donut based on your specific situation.

70-80% of patients start here

SciMed Silicone Ring Pessary

The workhorse pessary type for grade 1-3 prolapse. Sizes 0-9. From $49.99. Free US shipping.

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Quick decision tree

  • Grade 1-3 prolapse + intact pelvic floor: Ring pessary (with or without support)
  • Grade 3-4 prolapse OR failed ring retention: Gellhorn pessary
  • Grade 4 procidentia OR extensive prolapse with weak pelvic floor: Donut pessary
  • Small vaginal opening with mild prolapse: Ring pessary (fits smaller anatomy)
  • Post-hysterectomy vault prolapse: Gellhorn or donut typically preferred
  • Pediatric or infant urogenital prolapse (rare): Specialty pediatric pessary, provider-supervised

The 3 pessary types explained

Ring pessary (SciMed specialty)

The most common pessary type worldwide. Simple donut-shaped silicone ring that sits behind the pubic bone.

  • Best for: grade 1-3 prolapse, stress urinary incontinence (with-support model), pregnancy-induced prolapse
  • Insertion difficulty: easy — fold and insert like a diaphragm
  • Removal: hook a finger under the ring, pull down and out
  • Self-management: excellent — patients easily remove weekly for cleaning
  • Retention: good for most cases; may not retain in severe prolapse or weak pelvic floor
  • Comfort: very good — most patients cannot feel it once seated
  • Success rate: ~75-85% of appropriately-selected patients

Gellhorn pessary

Space-occupying pessary with a wide dish and a central stem. The dish sits in the upper vagina; the stem points toward the vaginal opening for retrieval.

  • Best for: grade 3-4 prolapse, post-hysterectomy vault prolapse, ring pessary failure
  • Insertion difficulty: moderate — often requires provider-assisted insertion first time
  • Removal: more complex — requires suction release, then rotation and extraction
  • Self-management: variable — some patients master it, others need clinic removal weekly
  • Retention: excellent — the space-occupying design resists expulsion
  • Comfort: good to very good once seated
  • Success rate: ~80-90% for appropriate patients

SciMed does not currently manufacture Gellhorn pessaries. If your provider recommends Gellhorn, source from an OB-GYN office (Milex or Bioteque supply).

Donut pessary

Large solid donut-shaped pessary that fills the vaginal space and resists expulsion in severe prolapse.

  • Best for: grade 4 prolapse (procidentia), severe pelvic floor weakness, patients unable to retain rings or Gellhorns
  • Insertion difficulty: difficult — typically requires provider insertion
  • Removal: difficult — typically requires provider removal
  • Self-management: limited — usually clinic-managed
  • Retention: excellent
  • Comfort: good but bulkier feel
  • Success rate: ~70-80% for appropriate patients

SciMed does not currently manufacture donut pessaries. Source through provider for Milex/Bioteque supply.

Direct comparison

Feature Ring Gellhorn Donut
Best prolapse grade 1-3 3-4 4
Self-insertion Easy Moderate Difficult
Self-removal Easy Moderate-difficult Difficult
Retention in severe prolapse Poor-fair Excellent Excellent
Sexual activity Can wear during Usually removed Usually removed
SciMed availability Yes (specialty) Not offered Not offered

How to escalate from ring to Gellhorn/donut

Sequence for patients where ring pessary is insufficient:

  1. Try ring pessary first — easiest, cheapest, most self-manageable
  2. If ring fails (expulsion, insufficient support): try larger ring size first (one size up)
  3. If larger ring still fails: try ring with support model if you were on plain ring
  4. If still fails: talk to provider about Gellhorn
  5. If Gellhorn fails or you can't self-manage: donut pessary or surgery

Most patients never need to escalate beyond the ring pessary. Ring is the correct answer 70-80% of the time.

Frequently asked questions

Should I start with a ring or Gellhorn pessary?

Start with ring for grade 1-3 prolapse. Escalate to Gellhorn only if ring fails after appropriate size trials. 70-80% of patients succeed with ring pessary as first choice.

Why doesn't SciMed sell Gellhorn or donut pessaries?

SciMed specializes in ring pessaries — the most common form for 70-80% of prolapse patients. For Gellhorn or donut, source through your OB-GYN office (Milex or Bioteque supply).

Can I switch between pessary types?

Yes. Many patients start with ring, then move to Gellhorn if needed. Some move back to ring after pelvic floor PT strengthens the support system.

Which type is best for grade 4 prolapse?

Donut usually, but ring or Gellhorn may work in some cases. Grade 4 typically requires provider-supervised selection and management.

Can I wear a Gellhorn during sex?

Usually not — the stem and shape make intercourse uncomfortable. Most patients remove Gellhorn before sex and reinsert after. Ring pessaries can typically stay in during intercourse.

Does insurance cover all three types?

Yes — all three are covered under HCPCS A4562 when medical necessity is documented. Provider prescription and prior authorization requirements vary by payer.

Related reading

Ring pessary specialists — sizes 0-9

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