The Gellhorn pessary is a firm, mushroom-shaped silicone device placed inside the vagina to support organs that have dropped out of position due to pelvic organ prolapse. It is one of the most commonly used space-filling pessaries, particularly for women with more advanced prolapse where softer, ring-style devices fail to hold. Its distinctive shape features a wide concave disc that sits against the cervix or vaginal cuff and a thick stem that rests at the vaginal opening, creating a suction-like effect that keeps prolapsed tissue in place. While pessaries in general have been around for centuries, the Gellhorn design occupies a specific niche in modern gynecology as a reliable second-line option when simpler devices are not enough.
What the Gellhorn Is Designed to Do
Pelvic organ prolapse happens when the muscles and connective tissue supporting the bladder, uterus, or rectum weaken enough that one or more of those organs bulge into or beyond the vaginal canal. The Gellhorn pessary physically props those organs back into a more anatomical position. Its broad disc creates a platform of support across a wider area than a ring-style pessary, and the suction generated between the disc and vaginal walls helps the device stay put even during coughing, straining, or standing for long periods.
Clinicians typically reach for the Gellhorn when a ring pessary has already been tried and either fell out or failed to adequately reduce the prolapse. In one study of 79 women with advanced prolapse who had failed ring pessary fitting, about 82% were successfully fitted with a Gellhorn at the initial appointment. At three months, roughly 71% of those women were still using the device, and all reported satisfaction with it.1PubMed. Successful use of the Gellhorn pessary as a second-line pessary in women with advanced pelvic organ prolapse That success rate positions the Gellhorn as a genuinely useful fallback before surgery enters the conversation.
How It Compares to Ring Pessaries
The ring pessary is usually the first device tried because it is easier to insert, remove, and manage at home. It sits like a flexible hoop inside the vagina, supporting the cervix from below. For mild to moderate prolapse, ring pessaries work well. But when prolapse is more severe, or the vaginal opening is wider than average, rings tend to slip out. That is where the Gellhorn steps in.
A retrospective study following 249 women over eight years found that both ring and Gellhorn pessaries had similar fitting success rates. The abandon rate was modestly higher for the Gellhorn at about 28% compared to about 21% for the ring, though both remained in use for the majority of women.2PubMed Central. Ring and Gellhorn pessaries used in patients with pelvic organ prolapse: a retrospective study of 8 years A randomized crossover trial comparing the two devices found that both produced meaningful improvements in prolapse-related symptoms and quality of life, with no clinically significant differences between the two in terms of symptom relief.3PubMed. The PESSRI study: symptom relief outcomes of a randomized crossover trial of the ring and Gellhorn pessaries
The practical difference is less about how well each device controls symptoms and more about which device physically stays in place for a given woman’s anatomy. If a ring holds, it is simpler to live with. If it does not, the Gellhorn is the natural next step.
Who Is Most Likely to Succeed with a Gellhorn
Anatomy matters more than almost anything else in determining whether a Gellhorn will work. Research consistently identifies total vaginal length as the strongest predictor of successful pessary fitting. Women with shorter vaginal canals are more likely to have trouble retaining any pessary, including the Gellhorn.4PubMed. Factors associated with pessary fitting in women with symptomatic pelvic organ prolapse: A large prospective cohort study One study using MRI found that vaginal length during straining was the single most important anatomical variable in predicting fitting success across pessary types.5PubMed Central. Explorative Identification of Anatomical Parameters Associated with Successful Pessary Fitting in Pelvic Organ Prolapse Using Dynamic Magnetic Resonance Imaging
A history of hysterectomy and a wider vaginal opening both predicted better results with the Gellhorn compared to the ring pessary.6PubMed. Which factors should be considered in choosing pessary type and size for pelvic organ prolapse patients in a fitting trial? This makes intuitive sense: after hysterectomy, the vaginal vault may lack the cervix that helps anchor a ring, and a wider introitus may allow a ring to slide out, while the Gellhorn’s suction mechanism provides a different kind of hold. The same study found that specific measurements like introitus width and the severity of apical and posterior prolapse guided the clinician in choosing the right Gellhorn size.
A prior history of pelvic reconstructive surgery also increased the odds of needing a Gellhorn or a ring with support, likely because surgical scarring and tissue changes alter the vaginal architecture enough that simpler devices no longer fit well.7PubMed. Factors associated with pessary fitting in women with symptomatic pelvic organ prolapse: A large prospective cohort study Meanwhile, a vaginal length under about 7.5 cm was identified as an independent risk factor for discontinuing the Gellhorn, since the disc simply cannot seat properly in a very short canal.8PubMed. Successful long-term use of Gellhorn pessary and the effect on symptoms and quality of life in women with symptomatic pelvic organ prolapse
Long-Term Retention and Dropout
The Gellhorn’s initial fitting success looks encouraging, but long-term continuation is a different picture. A study tracking women who self-managed their Gellhorn pessaries found that about a third had stopped using the device by one year, and half had discontinued by five years.9Female Pelvic Medicine & Reconstructive Surgery. Long-term Outcomes of Self-Management Gellhorn Pessary for Symptomatic Pelvic Organ Prolapse Those numbers are not disastrous, but they highlight the reality that pessary use is an ongoing commitment rather than a set-and-forget solution.
Reasons women stop vary. In a study of women over 80, the main reasons for discontinuing pessary use were perceived inconvenience, pain or discomfort, and either decreased daily activity or the feeling that prolapse symptoms were not bothersome enough to justify the hassle. A small number switched to surgery instead.10PubMed Central. Primary Treatment of Pelvic Organ Prolapse in Women Aged Over 80 Years: Pessary Versus Surgery This is worth knowing: a pessary does not have to be a permanent commitment. Some women use one for years, some for months while deciding about surgery, and some try it and decide they would rather pursue a different path.
Effects on Urinary, Bowel, and Sexual Symptoms
Pelvic organ prolapse rarely limits itself to a feeling of vaginal bulging. It often drags along urinary problems like difficulty emptying the bladder, frequency, or incontinence, as well as bowel symptoms like constipation or incomplete emptying. One of the Gellhorn’s strengths is that by repositioning prolapsed tissue, it often improves these associated symptoms too.
In a study following Gellhorn users over a median of nearly two years, women who continued with the device saw clinically meaningful improvements in both urinary and prolapse-related quality-of-life scores. The changes were large enough to be considered genuinely impactful rather than just statistically detectable.11PubMed. Successful long-term use of Gellhorn pessary and the effect on symptoms and quality of life in women with symptomatic pelvic organ prolapse Bowel symptoms also respond to pessary use: a one-year study found significant improvements in both bowel-related symptoms and bowel-related quality of life among women who stuck with their devices.12PubMed. The impact of pessary use on bowel symptoms: one-year outcomes
One common worry is whether a pessary interferes with sexual activity. A systematic review found reassuring results: in sexually active women who successfully used a pessary for prolapse, there was no deterioration in sexual function, and some evidence pointed to improvement.13PubMed. Do vaginal pessaries used to treat pelvic organ prolapse impact on sexual function? A systematic review and meta-analysis That said, the Gellhorn’s stem and disc can make intercourse physically difficult or impossible while the device is in place. Most women who are sexually active and use a Gellhorn remove it before sex and reinsert it afterward, which requires comfort with self-management.
Self-Management Versus Clinic-Based Care
Whether you manage the Gellhorn yourself or visit a clinic for regular removal and cleaning is one of the bigger practical decisions in pessary use. Self-care means removing the device periodically, washing it, and reinserting it on your own. Clinic-based care means returning to a provider every few months for these maintenance visits.
The Gellhorn is harder to self-manage than a ring pessary. Its rigid shape and suction mechanism mean that removal takes a bit of technique: you need to break the suction seal, often by hooking a finger around the disc’s edge, then guiding the device past the introitus. Reinsertion requires folding or angling the disc through the vaginal opening, which can feel awkward at first. Research reflects this difficulty. One study found that only about 31% of pessary users overall chose self-care, and those using the Gellhorn were more likely to be in the non-self-care group. Self-care patients tended to be younger, premenopausal, sexually active, and using ring-style pessaries.14Female Pelvic Medicine & Reconstructive Surgery. Rates of Pessary Self-Care and the Characteristics of Patients Who Perform it
Importantly, choosing clinic-based care does not seem to hurt long-term continuation rates. A meta-analysis found no statistically significant difference in continuation between self-care and clinic-managed pessary users.15PubMed. Self-care of vaginal pessary for pelvic organ prolapse: a systematic review and meta-analysis However, women who did not self-manage had higher rates of vaginal bleeding and erosion compared to self-care users.16Female Pelvic Medicine & Reconstructive Surgery. Rates of Pessary Self-Care and the Characteristics of Patients Who Perform it This likely reflects the longer continuous wear time when a provider visit is needed to remove the device. Among women over 80 specifically, about half of Gellhorn users were able to manage the device independently, compared to about 68% of ring pessary users.17PubMed Central. Primary Treatment of Pelvic Organ Prolapse in Women Aged Over 80 Years: Pessary Versus Surgery
Complications and What to Watch For
Pessary-related adverse events are common but mostly mild. A one-year study at a pessary clinic found that roughly 84% of women experienced at least one adverse event, with vaginal discharge, vaginal bleeding, and erosions being the most frequent. The Gellhorn and donut-style pessaries were about twice as likely to cause erosions compared to ring-with-support pessaries.18PubMed. Adverse events associated with pessary use over one year among women attending a pessary care clinic That elevated erosion risk is the Gellhorn’s main trade-off for its stronger support. The firmer disc and suction mechanism place more pressure on the vaginal walls, which can thin with age and estrogen loss.
Timing of maintenance appointments matters. Data from the COVID-19 pandemic, when many women went much longer than usual between pessary checks, showed that erythema and erosion increased in proportion to how long the pessary had been left in place. Severe tissue changes became more likely when the device had been in situ for at least 11 months without a visit.19PubMed. Effects of Delayed Pessary Maintenance Appointments on Patient’s Symptoms and Clinical Findings During the COVID-19 Pandemic This is a strong argument for keeping up with follow-up visits even when symptoms feel fine. If you are using clinic-based care, standard practice is typically a visit every three to six months for removal, cleaning, and vaginal inspection.
Vaginal estrogen cream is frequently prescribed alongside pessary use in postmenopausal women, with the logic that it helps keep vaginal tissue healthier and more resilient. The evidence on whether this actually prevents complications is surprisingly weak. A systematic review found no statistically significant reduction in ulceration, bleeding, or discharge with estrogen use.20PubMed. Effect of estrogen on vaginal complications of pessary use: a systematic review and meta-analysis A randomized trial reached a similar conclusion: no evident benefit from vaginal estrogen in preventing erosions, itching, or discharge among pessary users.21PubMed. ESTROgen use for complications in women treating pelvic organ prolapse with vaginal PESSaries (ESTRO-PESS)-a randomized clinical trial Despite this, many clinicians continue to prescribe it on the rationale that it has other benefits for vaginal health and is unlikely to cause harm. The honest answer is that the evidence does not clearly support estrogen as a pessary complication preventive, even though it may help with general vaginal comfort.
Rare but Serious Complications
Severe complications from pessary use are uncommon and overwhelmingly associated with neglected devices that go many months or years without being removed. When a Gellhorn is left in place too long, persistent erosions can progress to ulceration, infection, and in extreme cases, fistulas, which are abnormal connections between the vagina and an adjacent organ like the bladder or rectum.22Journal of Case Reports and Images in Obstetrics and Gynecology. Complication of Gellhorn pessary use
A systematic review of rare pessary complications found that the most frequently reported were vesicovaginal fistulas (about 25% of the case reports), rectovaginal fistulas (about 19%), vaginal impaction where the pessary becomes embedded in tissue (about 11%), and vaginal evisceration where small bowel protrudes through the vaginal vault (about 8%). Ring and Gellhorn pessaries together accounted for the vast majority of these cases. The median age in these reports was 82 years.23PubMed Central. Rare complications of pessary use: A systematic review of case reports One published case described an 89-year-old woman whose Gellhorn had been neglected for three years, resulting in the base of the disc migrating completely into the bladder and creating a large fistula that required surgical repair.24PubMed. Complications of neglected vaginal pessaries: case presentation and literature review
These cases, while alarming to read about, almost universally involve prolonged neglect in elderly patients who may have cognitive impairment, limited mobility, or lack of access to regular follow-up. A Gellhorn that is cleaned and checked on a reasonable schedule poses very little risk of anything beyond minor discharge or superficial irritation.
Whether the Gellhorn Changes Vaginal Flora
Because the Gellhorn sits against vaginal tissue for extended periods, some women worry about infections or disruption of normal vaginal bacteria. A cross-sectional study comparing vaginal flora in pessary users versus non-users found no significant difference in the types of bacterial communities present. Bacterial vaginosis was about three times more common in pessary users than in controls, but this difference was not statistically significant given the sample size. There was also no difference in rates of yeast infection between the two groups.25PubMed Central. Can the Pessary Use Modify the Vaginal Microbiological Flora? A Cross-sectional Study The discharge many pessary users notice is more often a mechanical effect of the device sitting against moist tissue than a sign of genuine infection, though any discharge with an unusual color or odor should still be evaluated.
When Surgery Becomes the Better Option
The Gellhorn pessary exists partly to delay or avoid surgery, and for many women it does exactly that. But it is not always the right long-term plan. Women who cannot tolerate the device, who have anatomy that does not hold any pessary reliably, or who simply find the maintenance burden unacceptable are reasonable candidates for surgical repair. In a study comparing pessary use and surgery in women over 80, only four out of the pessary group eventually crossed over to surgery, suggesting that once a pessary works, most women stick with it even at advanced ages.26PubMed Central. Primary Treatment of Pelvic Organ Prolapse in Women Aged Over 80 Years: Pessary Versus Surgery
The decision between pessary and surgery is not always permanent or binary. Some women use a Gellhorn for years while they are young enough that their prolapse might worsen with time, and then pursue surgery when their anatomy stabilizes or their life circumstances change. Others use one temporarily while waiting for a surgical date, or after surgery when prolapse recurs. The Gellhorn’s role in this landscape is as the workhorse space-filling pessary: the device most likely to succeed when simpler options have not, without requiring the recovery, risks, and permanence of an operation.