Pessary Ring With Support vs Without Support — Which Type Do You Need?
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The two most common ring pessaries prescribed in the US are the ring pessary with support and the ring pessary without support. Both treat pelvic organ prolapse non-surgically, but they differ in one critical feature: the with-support version has a silicone membrane across the middle of the ring. This guide covers when your OB-GYN would recommend one over the other.
Ring pessary with support vs without support — at a glance
| Feature | Ring With Support | Ring Without Support |
|---|---|---|
| Design | Silicone ring with membrane across center | Open silicone ring (no membrane) |
| Primary indication | Stage I–II prolapse + cystocele or stress urinary incontinence | Stage I–II prolapse alone |
| Bladder / urethra support | Membrane elevates bladder neck | Ring only — no bladder neck support |
| Wear during intercourse | Generally must be removed first | Can typically stay in place (open center allows penetration) |
| Difficulty of self-removal | Slightly easier — membrane provides grip | Requires hooking the ring rim |
| Sizes available | 0–8 (44–95 mm) | 0–9 (44–102 mm) |
| Price (SciMed direct) | From $49.99 | From $49.99 |
When your OB-GYN would recommend with support
1. You have stress urinary incontinence (SUI) alongside prolapse
If you leak urine when you cough, laugh, sneeze, or exercise, the with-support membrane elevates the bladder neck and can help reduce SUI symptoms. Many patients find their pessary functions as both a prolapse device AND an incontinence device.
2. You have a cystocele (bladder prolapse)
A cystocele is when the bladder bulges into the vagina. The with-support membrane provides direct anterior wall reinforcement that the open ring can't.
3. You want easier self-removal
The membrane gives you something to grip when removing the pessary. Patients with reduced hand dexterity often prefer the with-support design.
4. You are post-hysterectomy with vault prolapse
The support membrane distributes pressure more evenly against the vaginal walls in the absence of the cervix, reducing focal pressure spots.
When your OB-GYN would recommend without support
1. Sexual activity matters
The without-support open ring can typically stay in place during vaginal intercourse for most patients — the open center allows penetration. Sexually active patients without cystocele/SUI often prefer this design because they don't have to remove and reinsert.
2. You have prolapse alone (no urinary symptoms)
If your only symptom is a heaviness or bulging sensation without any urinary leakage, the without-support ring is the standard first-line device.
3. You want the simpler design for first-time use
Fewer moving parts. The open ring is easier to fold in half for insertion (though the with-support version also folds).
4. You need size 9 (102 mm)
In the SciMed range, size 9 is offered only in the ring pessary without support. Patients with post-hysterectomy vault prolapse or a very enlarged vaginal vault who need this size default to the open ring.
Can you switch from one type to the other?
Yes. Many patients start with the without-support ring, then switch to with-support if they develop cystocele symptoms or SUI later. Others start with the with-support ring and switch to without-support if the membrane feels intrusive.
Since sizes are equivalent across the two designs (a size 4 with-support fits the same anatomy as a size 4 without-support), switching between types doesn't usually require re-measurement — just a preference conversation with your provider.
What about other pessary types?
- Gellhorn — space-filling pessary for advanced (Stage III–IV) prolapse where a ring wouldn't hold. See ring vs Gellhorn comparison
- Donut — for severe uterine prolapse when a Gellhorn is contraindicated
- Cube — for very severe prolapse with poor vaginal support; requires daily removal
- Hodge / Smith — specialty pessaries for uterine displacement (rare, prescribed by urogynecologists)
All of these are options for cases where a ring pessary can't hold.
Order the type your provider recommended
- Ring Pessary With Support — from $49.99 (sizes 0–8) — for cystocele, SUI, or vault prolapse
- Ring Pessary Without Support — from $49.99 (sizes 0–9) — for prolapse alone, sexually active patients
- With-Support 2-Size Combo Pack — from $89.99 — if you're between sizes
- Without-Support 2-Size Combo Pack — from $89.99 — if you're between sizes
All SciMed ring pessaries are made in the USA and ship from California — same-day dispatch on orders placed before 2 PM PT. US shipping is a flat $9.99 under $100 and free at $100+. See all types and sizes on our ring pessary page.
FAQ
What is the difference between pessary with support and without support?
With support: silicone ring with a membrane across the center that elevates the bladder neck — preferred for patients with cystocele or stress urinary incontinence alongside prolapse. Without support: open silicone ring — preferred for prolapse alone, and for sexually active patients since the open center allows intercourse without removal.
Can I wear a ring pessary during sex?
The without-support open ring can typically stay in place during intercourse for most patients. The with-support version usually needs to be removed first because the membrane occupies the middle of the ring.
Do with-support pessaries treat urinary incontinence?
Yes. The with-support membrane elevates the bladder neck, which can help reduce stress urinary incontinence symptoms in patients with concurrent SUI and prolapse.
Are with-support and without-support pessaries the same size?
Yes. Sizes are numbered 0–8 (or 0–9 for without-support) and correspond to the same outer diameter measurements. A size 4 in either design fits the same anatomy.
Which is easier to remove — with support or without support?
Most patients find the with-support version slightly easier to grip and remove because the membrane provides something to hook.