Pessary Types Explained: Ring, Gellhorn, Cube and More

If you have been told a pessary might help with your prolapse, you probably have questions: what does it look like, how does it work, and which type is right for you? This guide explains the different types of pessaries in plain language, so you can feel informed and confident.

A pessary can be a life-changing treatment for pelvic organ prolapse and, for many women, it is one of the first things that makes a real difference to their comfort, confidence and quality of life. Yet pessaries are often not well understood, and many women tell us they felt unsure about what was being recommended or what their options were.

At Active Women’s Health, our pelvic health physiotherapists fit and manage pessaries as part of our everyday practice. We believe that the more you understand about your pessary options, the better equipped you are to make a decision that feels right for you.

This guide walks you through the most common types of pessaries, explains how they work, how they are fitted and what life with a pessary is really like.

What is a pessary?

A vaginal pessary is a small, removable medical device made of soft, medical-grade silicone. It is placed inside the vagina to provide physical support to the pelvic organs (the bladder, uterus and rectum) when their supports are lax or weak, causing them to sit lower.. This condition is called pelvic organ prolapse (POP).

Think of a pessary as a supportive structure, a bit like an internal splint, that holds the prolapsed organs in a more comfortable position. Pessaries do not cure prolapse, but they can significantly reduce symptoms such as the feeling of heaviness, dragging, bulging, and difficulty with bladder or bowel function. There is also emerging evidence of soft tissue remodelling and improved support over time after wearing a pessary.

Pessaries come in a range of shapes and sizes, and selecting the right one depends on the type and severity of your prolapse, your anatomy and your lifestyle. A trained pelvic health physiotherapist or medical practitioner will fit your pessary and help you find the right match.

Who can benefit from a pessary?

A pessary may be suitable for you if:

• You have been diagnosed with pelvic organ prolapse and are experiencing symptoms such as heaviness, bulging or discomfort
• You would like a non-surgical option to manage your prolapse
• You are waiting for prolapse surgery and want symptom relief in the meantime
• You want extra support for exercise, sport or physical activity
• Surgery is not recommended for you due to other health conditions
• You have had prolapse surgery in the past and symptoms have returned
• You are pregnant or have recently given birth and are experiencing prolapse symptoms

Pessaries are safe, well-tolerated and suitable for women of all ages: from younger women who are still active and exercising, through to older women who may not be candidates for surgery. If you are a candidate for a pessary, your physiotherapist will liaise with your GP or Specialist, to ensure you are cleared medically to have a pessary fitting.

Understanding the different types of pessaries

Pessaries can be broadly grouped into two categories:

Support pessaries

These sit inside the vagina and provide a shelf or platform of support beneath the prolapsed organs. They are the most commonly used type and are often the first choice for mild to moderate prolapse. Support pessaries are generally easier to insert and remove, making them well-suited to self-management.

Space-filling pessaries

These fill the vaginal space more completely, providing greater support for more advanced prolapse. They create a physical barrier that prevents the pelvic organs from descending into the vaginal canal. Space-filling pessaries are typically used when support pessaries are not sufficient.

Here is a guide to the most common pessary types your physiotherapist may discuss with you.

Ring Pessary

The ring pessary is the most commonly used pessary in Australia and is often the first type recommended.7 It is a flexible, circular ring made of soft silicone that sits in the upper part of the vagina.

Best for:
Mild to moderate prolapse (stages 1–3), particularly cystocele (bladder prolapse) and uterine prolapse.

How it works:
The ring sits behind the pubic bone and provides a shelf of support beneath the prolapsed organs.

Self-management:
Ring pessaries are one of the easiest types to insert and remove yourself, which means many women learn to manage them independently.

Activity:
Well-suited for active women — you can exercise, swim and go about your daily life with a ring pessary in place.

Comfort:
Most women cannot feel the pessary once it is correctly fitted.

Ring Pessary with support

This is a variation of the standard ring pessary with a silicone membrane stretched across the centre of the ring, creating a hammock-like support surface.

Best for:
Moderate prolapse where the standard ring does not provide enough support, or where there is a significant cystocele (bladder prolapse).

How it works:
The central membrane provides additional support directly beneath the bladder or uterus.

Self-management:
Can still be self-managed, though slightly more involved than a standard ring.

Note: Some women also find ring pessaries or ring with support pessaries helpful for mild stress urinary incontinence, as the membrane can provide gentle support to the urethra.

Dish Pessary

The dish pessary is a soft, flat, disc-shaped device designed to support the pelvic floor and manage mild pelvic organ prolapse and mild urinary leakage.

Best for:
Women experiencing mild urinary leakage and mild to moderate prolapse.

How it works:
The dish sits inside the vagina and provides a supportive base for the bladder and pelvic organs, helping to reduce the downward pressure that contributes to leakage.

Self-management:
Dish pessaries are generally suitable for self-management and can be removed, cleaned and reinserted at home.

Incontinence Dish with Knob Pessary

The dish with knob pessary is a variation of the standard dish, featuring a small projection on the upper surface that provides targeted support directly beneath the urethra.

Best for:
Women with stress urinary incontinence who have not found adequate symptom relief with a standard dish pessary.

How it works:
The knob applies gentle pressure under the urethra, helping to maintain closure during physical exertion and reducing unintentional leakage.

Self-management:
Like the standard dish, this pessary is generally suitable for self-removal and reinsertion at home, though the knob design can take a little more practice to position correctly.

Gellhorn Pessary

The Gellhorn pessary is a space-filling pessary shaped like a disc with a central stem (sometimes described as looking like a small mushroom or a round disc on a short stalk). It is the most commonly used space-filling pessary.

Best for:
More advanced prolapse (stages 3–4), particularly when a ring pessary has not provided sufficient support.

How it works:
The flat disc sits against the vaginal walls and the stem points downward. The disc fills the upper vaginal space, creating a physical barrier that holds the prolapsed organs in place.

Self-management:
Gellhorn pessaries can be more challenging to insert and remove than ring pessaries, though many women do learn to self-manage with practice and guidance from their physiotherapist.

Support level:
Provides stronger support than a ring pessary, making it a good option for women with significant prolapse who want to avoid or delay surgery.

Cube Pessary

The cube pessary is a small, cube-shaped device with concave (slightly hollowed) sides. It works differently from other pessaries as, rather than being held in place by the vaginal walls, the cube uses gentle suction to stay in position.

Best for:
Advanced prolapse, particularly when other pessary types have not stayed in place, or when the vaginal walls are wider and less able to hold a ring or Gellhorn pessary. This type can also be used prophylactically for high risk women who do not have prolapse, during sport and exercise.

How it works:
The concave sides of the cube create a gentle suction against the vaginal walls, which helps it stay in position even in situations where other pessaries might slip.

Self-management:
Cube pessaries must be removed daily (usually at night) to allow the vaginal tissue to rest and recover from the suction. This makes them more demanding to manage than ring or Gellhorn pessaries.

Important:
Because of the suction mechanism, cube pessaries should not be left in for extended periods without removal. Your physiotherapist will give you clear instructions on daily care.

Donut Pessary

The donut pessary looks like a thicker version of the ring pessary, with its shape being a donut or thick ring. It is a space-filling pessary that provides more support than a standard ring.

Best for:
Moderate to advanced prolapse, often used as an alternative to the Gellhorn when a ring pessary does not provide enough support.

How it works:
The thicker body of the donut fills more of the vaginal space, providing greater support to the prolapsed organs.

Self-management:
Can be more difficult to fold and insert than a ring pessary due to its thickness. Some women self-manage; others prefer to have their physiotherapist manage changes.

Shaatz Pessary

The Shaatz pessary is disc-shaped, similar to a Gellhorn but without the central stem. It provides a flat, broad surface of support.

Best for:
Moderate to advanced prolapse, particularly when a Gellhorn is too difficult to remove due to the stem.

How it works:
The flat disc sits in the upper vagina and provides a wide area of support.

Self-management:
Easier to remove than a Gellhorn for some women, as there is no stem to navigate.

How is a pessary fitted?

How your pessary is selected

Choosing the right pessary is not a one-size-fits-all process. Your physiotherapist will consider several factors when recommending a pessary type and size:

What happens during a fitting

A pessary fitting is a straightforward clinical procedure, usually done in a single appointment. Your physiotherapist will start by talking with you about your symptoms, goals and preferences. They will then carry out a pelvic examination to check your prolapse and the shape of your vagina, before selecting an initial pessary type and size to try. The pessary is inserted gently, using a water-based lubricant for comfort.

Once it’s in place, you will be asked to stand up, walk around, cough and use the bathroom. This helps check that the pessary feels comfortable, stays where it should and doesn’t get in the way of your bladder or bowel function. If the first one doesn’t feel quite right, that’s completely normal, your physiotherapist will simply try a different size or type. Many people need to try more than one pessary before finding the best fit.

Once you have the right pessary, your physiotherapist will explain how to look after it and, if it suits you, teach you how to remove and reinsert it yourself. Finding the right fit can sometimes take more than one appointment, and that’s perfectly normal too. The goal is to find a pessary that feels comfortable, works well and suits your life.

To learn more read our What to expect at your pessary fitting blog.

Self-Management: Learning to care for your pessary

Many women learn to insert, remove and clean their pessary themselves and this is something we actively encourage and support. Self-management gives you greater independence and flexibility, and research shows that women who self-manage tend to continue using their pessary for longer.

Your physiotherapist will teach you the technique step by step, at your own pace, and will be available for follow-up support whenever you need it. Not all pessary types are equally suited to self-management. Ring pessaries are generally the easiest to self-manage, while Gellhorn and cube pessaries require a bit more practice.

If you prefer not to self-manage, that is also completely fine. Your physiotherapist can manage your pessary for you at regular clinic appointments.

Living with a pessary: What to expect

Daily comfort and activity

When your pessary is well fitted, you should not be able to feel it during your normal daily activities. Most women report an immediate improvement in their prolapse symptoms, such as less heaviness, less bulging, and greater comfort when standing, walking and being active.

You can continue all your usual daily activities with a pessary in place, including going to the bathroom. Pessaries do not interfere with urination or bowel movements when correctly fitted.

Exercise and activity with a pessary

One of the most common reasons women choose a pessary is to be able to exercise with greater comfort and confidence. With a well-fitted pessary, many women return to activities they had stopped or reduced because of prolapse symptoms.

You can generally: walk, jog and run; swim; go to the gym (including weights, classes and cardio equipment); practise yoga, pilates or other group exercise; and play sport.

Your physiotherapist will advise you on any specific considerations based on your type of pessary and your prolapse. Combining a pessary with pelvic floor muscle training gives you the best support for staying active.

Pessary care and maintenance

Proper care of your pessary is important for your comfort and vaginal health. Your physiotherapist will give you specific instructions based on your pessary type, but here are some general guidelines:

• Ring and Gellhorn pessaries — remove, wash with mild soap and water, and reinsert at least every week. Your physiotherapist will recommend a schedule that suits you.
• Cube pessaries — must be removed daily (usually at night) to allow vaginal tissue to rest. Wash with mild soap and water before reinserting.
• Use a water-based lubricant when reinserting your pessary to help with comfort.
• Arrange regular review appointments with your GP or medical specialist for a speculum check every 3- 6 months. Your physiotherapist will write a letter to your doctor after the fitting to request this.
• Contact your physiotherapist if you have any difficulty with insertion or removal of the pessary. These issues can usually be resolved quickly with a review appointment and a pessary adjustment or change.