Pessaries: Types, How They Work, and What to Expect From Fitting and Use
Pessaries: Types, How They Work, and What to Expect From Fitting and Use
Pessaries have been used in the management of pelvic floor conditions for over a century, and modern medical-grade silicone pessaries represent a safe, well-tolerated option for many patients who prefer to avoid or delay surgical intervention. Understanding the different types and their intended purposes helps patients have more informed conversations with their clinicians.
What Is a Pessary and How Does It Work?
Pelvic organ prolapse affects a significant portion of women, particularly after childbirth and with advancing age. Pessaries are appropriate across a range of severity — from mild prolapse where a conservative approach is preferred, to significant prolapse where surgery is not yet indicated or desired. The right pessary type depends on anatomy, degree and type of prolapse, the patient's ability to self-manage, and personal preference — all requiring clinical assessment.
The Six Primary Pessary Types
Each pessary type is designed for a specific anatomical situation and degree of prolapse. The clinical decision about which is appropriate for a specific patient belongs to the healthcare provider. These descriptions explain the options your clinician may discuss.
The ring pessary is the most commonly fitted type and the starting point for most pessary fittings. Its flexible ring sits diagonally across the vaginal canal, supporting pelvic organs while allowing normal secretions to pass. Many patients with good manual dexterity can learn to insert, remove, and clean a ring pessary independently. Ring pessaries are available with or without a support membrane — the supported version provides additional elevation for a prolapsed bladder or anterior vaginal wall. The appropriate variation is determined at fitting.
The Gellhorn uses a disc-and-stem design providing more comprehensive support than a ring pessary, making it appropriate for more significant prolapse. Because the Gellhorn fits more securely, self-removal can be technically challenging — many patients have it removed and cleaned by their clinician at regular follow-up appointments rather than managing independently at home.
The donut pessary is a thick, solid ring designed for more advanced prolapse where a standard ring pessary would not provide adequate structural support. Its greater volume fills the vaginal canal more completely, providing the support needed when significant descent of pelvic organs has occurred. Typically managed by a healthcare provider given the difficulty of self-removal.
The cube pessary has concave sides that create a gentle suction effect against the vaginal walls, providing retention in situations where other shapes would be displaced. Reserved for severe prolapse cases. Available with or without drainage holes. Because of the suction retention mechanism, cube pessaries require removal for cleaning — often nightly. This daily management requirement should be an important factor in the clinical decision about whether a cube pessary is practical for a specific patient.
The Gehrung uses an arch design that supports both the anterior and posterior vaginal walls simultaneously — appropriate for complex prolapse patterns where descent is occurring in multiple compartments. Its fitting is more technically involved than standard ring or donut pessaries and requires experienced clinical assessment.
Designed specifically for stress urinary incontinence — involuntary leakage during physical activity, coughing, sneezing, or exertion. The knob component positions under the urethra and reduces urethral movement during increases in abdominal pressure. Available with or without a support membrane for concurrent cystocele management. Many patients can manage this type independently with proper instruction from their clinician.
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Fitting, Follow-Up, and Daily Use — What to Expect
The Initial Fitting
A pessary fitting involves pelvic examination, trial of one or more types and sizes, assessment of retention during simulated activity, and self-management instruction if applicable. The first fitting is not always the final answer — some patients need a different size or type after trying the initial recommendation, and follow-up adjustment is normal and expected.
Follow-Up Is Not Optional
Most clinicians see patients 2–4 weeks after the initial fitting to confirm fit, comfort, and absence of complications. Ongoing follow-up varies — typically every 3–6 months for provider-managed pessaries, or annually for independent self-managers. Skipping follow-up is associated with increased risk of vaginal erosion, infection, and other preventable complications.
Self-Management vs Provider Management
Ring pessaries and incontinence rings can typically be self-managed by patients with adequate manual dexterity — removed, washed, and reinserted at regular intervals. Gellhorn, Donut, and Cube pessaries are more typically managed at clinical visits. Which approach is appropriate depends on both the pessary type and the patient's physical capability — discuss this explicitly with your clinician at fitting.
Hygiene and Cleaning
All pessaries require regular cleaning. General guidance: remove and wash with mild soap and warm water; rinse thoroughly; inspect for damage; allow to dry before reinsertion or storage. Avoid harsh chemicals or boiling unless the manufacturer's instructions specifically permit it. Report any vaginal discharge, odor, discomfort, or difficulty with removal to your clinician promptly.
Frequently Asked Questions
Can I determine my own pessary size?
No. Pessary sizing requires clinical examination. The size that fits correctly depends on vaginal dimensions and anatomy that can only be assessed by a healthcare provider during a physical examination. Ordering a pessary without a clinical fitting and size determination is not appropriate and may result in a device that does not provide adequate support or causes injury.
How long can a pessary be worn between removals?
This depends on the pessary type and your clinician's guidance. Ring pessaries in self-managing patients are often removed weekly or every few weeks for cleaning. Gellhorn and Donut pessaries managed by a clinician are removed at follow-up visits. Cube pessaries are often removed nightly. Follow your clinician's specific instructions rather than general recommendations.
Will a pessary affect sexual activity?
This depends on the type. Ring pessaries can sometimes be left in place during intercourse; Gellhorn, Donut, and Cube pessaries are typically removed beforehand. Discuss this with your clinician at fitting — they will advise based on the specific device and your situation.
Can I use a pessary after a hysterectomy?
Yes — pessaries can be used after hysterectomy. Vault prolapse following hysterectomy is a specific situation that certain pessary types address. Your clinician will assess the anatomy and recommend the appropriate type if pessary management is suitable for your situation.
Are pessaries covered by insurance or Medicare?
Coverage varies by plan. Many insurance plans cover pessaries when prescribed for a documented clinical indication. Medicare Part B covers pessaries as durable medical equipment when medically necessary and properly documented. Contact your insurer with the HCPCS code for your prescribed pessary to confirm coverage before ordering. Call us at 866-218-0902 for guidance on the ordering process.
What is the difference between a pessary and surgery for prolapse?
A pessary provides mechanical support without altering anatomy — it is a conservative, reversible treatment. Surgical repair addresses the underlying anatomical defects and may provide more durable correction but carries surgical risks and recovery. Many patients use pessaries as a long-term management strategy; others use them as a bridge to planned surgery. The decision between conservative and surgical management is a clinical conversation for a qualified pelvic floor specialist.
Ready to order? We can help.
Once your clinician has determined the right pessary type and size, we supply all major types with fast nationwide delivery. Call us with the type and size your provider has specified.
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