Types of Pessary for Successfully Treating Prolapse With Pros and Cons

Many types of pessary are designed for prolapse management.

Fitting the right pessary usually involves trial and error.

Women often need to try out a number of different pessaries to get the right fit.

The type of pessary you’re fitted with determines the overall success of conservative prolapse management so it helps to know your options.

This Pelvic Floor Physical Therapy information helps you know:

• Common reasons for using a pessary
• Different types of pessary for treating vaginal prolapse including of advantages and disadvantages of:

1. Ring pessary
2. Gehrung pessary
3. Donut pessary
4. Cube pessary
5. Gellhorn pessary
6. Inflatable pessary
7. Shelf Pessary

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Common Reasons for Using a Pessary

Some of reasons for using a pessary are:

• Desire to avoid or delay prolapse surgery
• Waiting for prolapse surgery
• Exploring alternatives to prolapse surgery
• Desire to exercise safely with a prolapse
• Desire for future pregnancy

Types of Pessary for Treating Vaginal Prolapse

There are many different types of pessary designed for managing prolapse.

Pessaries are manufactured in different sizes to suit individual differences in internal dimensions.

The types of pessary best suited to managing your prolapse depends upon your:

1. Type of prolapse
2. Prolapse severity i.e. mild, moderate or severe
3. Vaginal dimensions

Pessaries can be grouped into 2 categories:

1. Support pessaries that elevate or lift up the prolapsed tissues within the vagina usually for mild to moderate prolapse e.g. Ring or Gehrung pessary
2. Space occupying pessaries that fill the space within the upper vagina usually for more advanced or severe prolapse e.g. Donut, Cube or Gellhorn pessary.

1. Ring Pessary 

The Ring pessary is the most commonly fitted pessary (shown right). This type of pessary is a support pessary and it’s usually the first style of pessary trialled during fitting.

Ring pessaries are available in a couple as a ring only or combined with a small block design to manage prolapse and stress urinary incontinence (bladder leakage with cough or sneeze). The additional block supports the urethra (urine tube) with the goal of reducing leakage when pressure is placed upon the bladder.

Pros and Cons

• Easily inserted and removed
• Used for most types of prolapse
• Patients can usually be taught to remove this pessary themselves
• Does not need to be removed for intercourse

Prolapse Type

Suited to all types of prolapse

Prolapse Severity

Mild to severe (best suited to less severe mild to moderate prolapse).

2. Gehrung pessary 

The Gehrung pessary is a support pessary (shown right).

Pros and Cons

• The Gehrung pessary can be moulded or customized to fit
• Does not need to be removed for intercourse
• Provides strong support
• Difficult to fit and remove

Prolapse Type

The Gehrung can be used for cystocele, rectocele and /or uterine prolapse

Prolapse Severity

Mild to severe (best suited to less severe i.e. mild to moderate prolapse).

Donut Pessary 

The Donut is a space occupying pessary (shown right).

Pros and Cons

• Used  for different types of prolapse including uterine prolapse
• Difficult to remove owing to size and thickness (difficult to squeeze and compress)
• Donut pessary needs to be removed for intercourse

Prolapse Type

The Donut can be used for different types of prolapse including cystocele, rectocele and/or uterine prolapse.

Prolapse Severity

Most suitable for moderate to severe prolapse.

Cube Pessary 

The Cube is a space occupying pessary (shown right).

The Cube pessary has curved surfaces that adhere (stick) to the walls of the vagina. The Cube is attached to a plastic loop (like a tampon string) that sits within the vagina to assist removal.

Pros and Cons

• Needs to be removed every night
• Difficult to insert and remove
• Cube pessary needs to be removed for intercourse
• Sometimes associated with increased vaginal discharge
• May cause vaginal erosion

Prolapse Type

The Cube can be used for different types of prolapse including cystocele, rectocele and/or uterine prolapse.

Prolapse Severity

Most suitable  for moderate to severe prolapse.

Gellhorn Pessary 

The Gellhorn pessary is a space-occupying pessary. It has a circular base with a curved surface. The curved surface provides suction keeping the pessary in place.

Pros and Cons

• Difficult to insert and remove.
• Removal requires the use of forceps to grasp the stem of the pessary
• The position in the vagina can change
• Gellhorn pessary needs to be removed for intercourse

Prolapse Type

The Gellhorn pessary be used for different types of prolapse including cystocoele, rectocele and/or uterine prolapse.

Prolapse Severity

Most suitable for moderate to severe prolapse.

6. Inflatable Pessary 

Inflatable pessaries are manufactured in Donut and Ball designs. These are space occupying pessaries. They have a tampon-like extension for inflation and removal. Inflatable pessaries are expanded using a hand held pump once fitted in position.

Pros and Cons

• Easy to insert and remove
• Inflatable pessary needs to be removed for intercourse

Prolapse Type

Suitable for use with uterine, cystocele, rectocele, small bowel and/or rectum.

Prolapse Severity

Suits mild to severe prolapse depending on the type of prolapse.

7. Shelf Pessary 

The Shelf pessary is a rigid type of pessary suited to more advanced prolapse. More flexible silicone Shelf pessaries have recently been manufactured.

Pros and Cons

• Difficult to insert and remove
• Shelf pessary needs to be removed for intercourse

Prolapse Type

Suitable for use with prolapsed uterus or procidentia (prolapse protrudes out of vagina)

Prolapse Severity

Suits moderate to severe forms of prolapse.

Types of Pessary Key Points

• There are many different types of pessary for managing prolapse
• Pessaries are manufactured in a range of sizes
• Different types of pessary are designed for managing a specific type of prolapse
• The Ring pessary is the most commonly fitted pessary for managing vaginal prolapse
• Getting the right pessary often involves trialling a range of styles and/or sizes

Further Reading

» Pessary Fitting for Prolapse – How to Know if Your Pessary Fits Well

» How Pessaries Can Help Prolapse Symptoms And Support

» How Severe is Your Prolapse? Understanding Your Prolapse Diagnosis

ABOUT THE AUTHOR, Michelle Kenway

Michelle Kenway is an Australian Pelvic Floor Physiotherapist. Michelle lectures to health professionals and promotes community health through her writing, radio segments, online exercise videos and community presentations. She holds dual post graduate physiotherapy qualifications in women’s health and exercise.

References

Viera A.  & Larkins-Pettigrew M. (2000) Practical use of the Pessary. Am Fam Physician.May 1;61(9):2719-2726.

Jones K. & Harmanli O. (2010) Pessary Use in Pelvic Organ Prolapse and Urinary Incontinence. Rev Obstet Gynecol. Winter; 3(1): 3–9.