Which Pessary for Your Prolapse Stage? A Stage 1–4 Guide

If your doctor told you that you have "stage 2" or "stage 3" prolapse, you may be wondering what that means for you, and which pessary makes sense. This guide explains each stage in plain words, shows which pessary types clinicians usually consider at each one, and helps you know what to ask at your next visit.

This article is general information. It does not replace an exam or advice from your own doctor, nurse practitioner or pelvic floor therapist.

What the prolapse stages mean

Pelvic organ prolapse happens when the bladder, uterus, rectum or top of the vagina drops down because the supporting tissues have weakened. Doctors often describe how far it has dropped using the POP-Q system. It measures the lowest point of the prolapse against the hymen, which is the tissue ring at the vaginal opening, while you bear down (MSD Manual).

• Stage 1: The prolapse is still well inside the vagina, more than 1 cm above the opening.
• Stage 2: The prolapse reaches the vaginal opening, within 1 cm above or below it.
• Stage 3: The prolapse comes more than 1 cm outside the opening, but not all the way.
• Stage 4: The vagina or uterus is fully turned out (complete prolapse).

Some doctors use simpler words like "mild" or "moderate," or an older system with "grades." The idea is the same: the higher the number, the further the prolapse has dropped.

One important point: the stage does not decide treatment on its own. Treatment is based on your symptoms and how much they bother you (MedlinePlus). A woman with stage 2 prolapse and daily pressure may want a pessary. A woman with stage 1 and no symptoms may need nothing at all.

Pessary type by stage: a simple overview

The table below shows what clinicians commonly consider at each stage. It is a starting point for a conversation, not a prescription.

Stage	What it means	Pessary types often considered
1	Mild, well inside the vagina	Often none if no symptoms. If bothered: pelvic floor exercises, or a ring with or without support
2	Reaches the vaginal opening	Ring pessary, usually the first choice. With support if the bladder has dropped or you leak
3	Bulges outside the opening	Ring with support often tried first; a larger size or a Gellhorn if it will not stay in
4	Fully outside	Gellhorn or other space-filling pessary is common; a ring works for some women

A clinical review in OBG Management notes that a ring pessary can be used for all stages of prolapse. It cites a study in which ring pessaries were fitted successfully in 100% of women with stage 2 prolapse and 71% with stage 3, while Gellhorn pessaries did best in stage 4, at 64% (Tam et al., OBG Management). These numbers come from one study group, so your own result may differ. Still, they show why rings are the usual starting point.

Stage 1 and stage 2: where a ring pessary fits best

At stages 1 and 2, the prolapse is still inside or just at the opening. This is where ring pessaries tend to work well, because the ring has enough vaginal wall around it to stay in place.

Ring with support or without support?

Both are rings. The difference is a thin, flexible membrane across the middle.

• Ring with support has the membrane. It gives extra support under the bladder, so it is often chosen for a dropped bladder (cystocele) or for leaking when you cough, laugh or lift.
• Ring without support is an open ring. It is a simple option for uterine prolapse when leaking is not a concern.

For a side-by-side look, see our guide on ring with support vs without support.

Stage 3: a ring is often still worth trying

Many women with stage 3 prolapse are surprised to learn that a ring may still work for them. The same review notes that a higher stage does not, on its own, predict that a pessary will fail. A ring with support is often tried first because it is easy to remove and clean, and many women can learn to manage it at home.

If the ring slips out when you strain, your clinician may try a different size first. If that does not work, they may suggest another type. Things that can make fitting harder include a short vagina, a wide vaginal opening, past pelvic surgery and a weak back vaginal wall (Tam et al.). None of these are your fault. They simply mean it may take a few tries to find the right fit.

Stage 4: when a ring may not be enough

At stage 4, the prolapse is fully outside the body. A ring can still work for some women, but clinicians often turn to a space-filling pessary such as a Gellhorn. According to the International Urogynecological Association, the Gellhorn is often used for more serious prolapse and usually needs to be removed by a doctor or nurse, while some women using ring pessaries can remove, clean and replace them on their own (IUGA patient leaflet).

To be clear: SciMed makes ring pessaries, not Gellhorn pessaries. If you have stage 4 prolapse, please see a gynecologist or urogynecologist in person. Our page on ring vs Gellhorn pessaries explains the main differences so you can talk it through with them.

How to choose the right size

Stage tells you how far the prolapse has dropped. Size is a separate question, and it depends on your body, not your stage. SciMed sizes run 0–9 without support and 0–8 with support, and sizes 3–5 are the most common.

• Best: get sized at a fitting with your clinician, then reorder that exact type and size.
• If you are between sizes: ask your clinician whether trying two or three nearby sizes makes sense. Our 3-size fitting pack ($129.99) lets you have neighboring sizes on hand.
• Learn more: our ring pessary size guide explains how sizes are measured.

A pessary that fits well should not be felt when you sit, walk or bend. Pain, bleeding, trouble passing urine or a pessary that keeps falling out are signs to call your clinician.

Questions to ask at your next visit

• What stage is my prolapse, and which organ is involved (bladder, uterus, rectum)?
• Would a ring with support or without support suit me better?
• What size did you fit, and can you write it down for me?
• Can I remove and clean it myself, or should the clinic do it?
• How often should I come back for a check?

Our article on what happens at a pessary check-up covers follow-up visits in more detail. If you are also weighing surgery, see pessary vs surgery: how to decide.

Frequently asked questions

What pessary is best for stage 2 prolapse?

For many women with stage 2 prolapse, a ring pessary is the usual first choice. A ring with support is often picked when the bladder has dropped or there is leaking with coughing or sneezing. A ring without support is a simpler option when leaking is not a problem. Your clinician confirms the type and size at a fitting.

Can a ring pessary work for stage 3 prolapse?

Often, yes. In one study cited in a clinical review, ring pessaries were fitted successfully in about 71% of women with stage 3 prolapse. If a ring keeps slipping out, your clinician may try a different size or a different type, such as a Gellhorn.

What pessary is used for stage 4 prolapse?

Stage 4 means the prolapse is fully outside the body. A ring can still work for some women, but clinicians often turn to a space-filling pessary such as a Gellhorn, which usually needs to be fitted, removed and cleaned by a doctor or nurse. This stage needs an in-person exam.

Do I need a pessary for stage 1 prolapse?

Not always. Treatment is usually based on symptoms, not the stage alone. If a mild prolapse does not bother you, your clinician may suggest watching it and doing pelvic floor exercises. If you have pressure or leaking, a pessary is one option to discuss.

How do I find out my prolapse stage?

Your stage comes from a pelvic exam by a doctor, nurse practitioner or pelvic floor physical therapist. They check how far the prolapse moves while you bear down. You cannot reliably stage it yourself at home, so ask your clinician to write your stage, pessary type and size in your notes.

Written by the SciMed Clinical Team. This article is for general education and is not medical advice. Please talk with your doctor or pelvic health clinician about your own situation.