Circular, flat plate with a stem in the centre which stabilises the pessary in the vagina
Gellhorn pessaries are a circular, flat plate with a stem in the centre which stabilises the pessary in the vagina. It is often considered for a woman who has more advanced prolapse or who needs additional support. The cervix or vaginal vault rests behind the flat plate of the pessary and the stem should only be visible at the introitus when the woman performs a Valsalva manoeuvre (strains downwards). [1]
According to the POGP UK Clinical Guideline for Best Practice, the Gellhorn is often considered for women with more severe uterovaginal or apical prolapse, including post-hysterectomy vaginal vault prolapse, where greater mechanical support is required.[1] Its flat disc and central stem allow the cervix or vaginal vault to rest behind the plate, providing support for significant pelvic organ descent.
A Gellhorn pessary may be particularly appropriate where simpler support pessaries are repeatedly expelled or a space-occupying device is needed to maintain prolapse reduction. Patient selection should consider prolapse severity, individual anatomy, vaginal tissue health, functional goals, and the patient’s ability to manage the device.[1] As insertion and removal can be more difficult than with ring pessaries, self-management may be challenging and clinician-led follow-up is often required. It may also be less suitable for women wishing to maintain penetrative vaginal intercourse, although individual experiences vary.
Contraindications and precautions are broadly consistent with other vaginal pessaries. Careful assessment is required where there is active vaginal or pelvic infection, significant vaginal ulceration, unexplained vaginal bleeding, or where reliable follow-up cannot be assured. Manual dexterity, cognitive function, and willingness to attend regular reviews should also be considered when determining whether a Gellhorn pessary is an appropriate management option.
Most Gellhorn pessaries are made of a flexible silicone material, however rigid silicone and acrylic varieties are available. They are sized in two ways; the first in the same way as a ring pessary to determine the outer diameter size of the circular plate (available in 38–95 mm or equivalent inches) and secondly the vaginal length must be considered to enable a choice between a standard-length stem or short stem. The pessary has drainage ports to allow the passage of fluids, although they do not readily allow drainage of menstrual flow. [1]
Explore the standard and short stem length here.
There are two options for Gellhorn pessary fitting depending on the estimated size of the Gellhorn and the size of the introitus: [1]
1. Holding it with the stem flattened sideways to compress the pessary, the edge of the plate is introduced first; once half of the plate is inside the vagina, the pessary is then rotated into a horizontal position whilst pushing it upwards at the same time so that the edge is placed in the posterior fornix with the stem sitting in the centre of the vagina. [1]
2. Folding the plate of the pessary behind the stem, the pessary is then introduced into the vagina and pushed towards the posterior fornix, with the stem sitting in the centre of the vagina. [1]
A finger needs to be introduced to the side of the plate to move it and release the suction. Once the plate is mobile, the pessary should be folded by placing the middle finger around the stem. The index finger is then hooked round the edge of the plate folding it towards the stem whilst also bringing it down to the introitus.[1]
Effective management of a Gellhorn pessary requires regular clinical review to ensure continued symptom relief and to monitor for complications. Following fitting, patients should be assessed for comfort, pessary retention, urinary and bowel function, and any signs of vaginal irritation or discharge. The POGP guidelines state that most commonly, reviews take place every 3–6 months. [1]
| Gellhorn Pessary | Ring Pessary | Shaatz Pessary | Shelf Pessary | |
| Primary Function | Space-occupying and supportive | Supportive | Supportive | Supportive and space-occupying |
| Prolapse Severity | Moderate to severe | Mild to moderate | Moderate | Severe |
| Ease of Fitting | Moderate | Easy | Easy to moderate | More complex |
| Self-management | More challenging | Generally easiest for self management | Often suitable for self-management | Typically clinician-managed |
What size Gellhorn pessary should I use?
The appropriate size is determined through a clinical assessment of the patient’s vaginal anatomy, prolapse severity, and the ability of the pessary to remain comfortably in place during normal daily activities.
Gellhorn pessaries are available in a range of diameters and stem lengths.
Click here to learn more about the available sizes of the Gellhorn Pessary
Click here to learn more about the available sizes of the Gellhorn Pessary Short Stem
Can a Gellhorn pessary be self-managed?
Self-management of a Gellhorn pessary is possible for some women, but it is generally more challenging compared with simpler pessary types such as a ring pessary. This is due to its design, which includes a firm disc and central stem that can make both removal and reinsertion more technically difficult and require a higher degree of manual dexterity and comfort with vaginal self-examination.
What is the difference between a Gellhorn and a Shaatz pessary?
A Gellhorn and a Shaatz pessary are both used in the management of POP, but they differ in design, mechanism of support, and typical clinical use. The Gellhorn pessary consists of a flat, disc-shaped base with a central stem, creating a space-occupying device that provides strong support for more advanced prolapse. In contrast, the Shaatz pessary is a ring-shaped pessary with a thicker posterior segment, designed to provide support while remaining relatively simple in structure.
What follow-up is required after a Gellhorn pessary is fitted?
Follow-up after fitting a Gellhorn pessary is essential to ensure correct positioning, symptom relief, and vaginal tissue health. An initial review is usually arranged within a few weeks of fitting to assess tolerance, comfort, and effectiveness.
Ongoing review intervals are individualised but commonly occur every 3 to 6 months for clinician-managed patients. During follow-up, the pessary is removed, cleaned, and the vaginal tissues are examined for signs of pressure effects, ulceration, discharge, or infection.
Are you interested in learning more or viewing the available sizes?
References:
1. Pelvic Obstetric and Gynaecological Physiotherapy (2025). POGP Clinical Competency Framework for Pelvic, Obstetric and Gynaecological Physiotherapy. United Kingdom: POGP Education Committee. pgg_guidance_v8copy_2.pdf
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