Ring Pessary vs Gellhorn vs Cube — Which Type Do You Need?
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If your provider has suggested "a pessary" without specifying type, or if you're researching online and seeing multiple shapes, here's the honest breakdown. SciMed sells only ring pessaries because that's what fits 75-80% of patients — but knowing the alternatives helps you understand your provider's recommendation.
The three main types at a glance
| Feature | Ring | Gellhorn | Cube |
|---|---|---|---|
| Shape | Open silicone ring (like a donut) | Disc with a stem (like a small drain plug) | Silicone cube with concave sides |
| How it stays in | Wedged behind pubic bone | Suction from disc + stem hooks against cervix | Suction against vaginal walls |
| Prolapse severity | Stage I-II | Stage II-III (advanced) | Stage III-IV (severe) |
| Self-removable? | Yes — easy | Sometimes — stem can be difficult | No — provider removal usually needed |
| Wear during sex? | Yes (open ring) | No | No |
| Cleaning frequency | Weekly | Weekly-monthly | Daily removal recommended |
| Available at SciMed? | Yes | No — provider-fitted | No — provider-fitted |
Ring pessary — first-line for most patients
The ring pessary works for the majority of prolapse cases because it uses the pubic bone as an anchor. It's simple, self-manageable, and comfortable for long-term daily wear. ACOG Practice Bulletin No. 214 recommends the ring as first-line for Stage I-II prolapse.
Two variants: Ring Without Support (open ring for prolapse alone) and Ring With Support (adds membrane for cystocele or SUI). Both are FDA Class II cleared, USP Class VI silicone, made in San Jose CA at $49.99 direct.
Gellhorn — when the ring won't stay in
The Gellhorn is used when a ring pessary keeps falling out because prolapse has advanced beyond what the ring can hold. It has a flat disc that sits against the cervix and a small stem for removal. Fitting requires a provider — the disc-and-stem geometry needs professional sizing.
Downsides: harder to self-remove (some patients need provider help), cannot be worn during intercourse, more likely to cause discharge.
Cube — severe cases only
The cube pessary relies on active suction between its concave sides and the vaginal walls. It's reserved for severe prolapse (Stage III-IV) where ring and Gellhorn both fail. Requires daily removal to prevent tissue damage — the constant suction can erode tissue if left in continuously.
Cube pessaries are almost always provider-managed, not patient self-care.
How to know which type is right for you
- Doctor gave you a specific type — follow their recommendation. They know your prolapse stage from exam.
- New to pessaries, prolapse feels manageable — start with the ring. If your provider hasn't specified with-support vs without-support, the Ring With Support is more versatile (handles prolapse + cystocele).
- Tried a ring before and it fell out — you probably need Gellhorn. See your provider before ordering.
- Between two sizes on the ring — try our 3-Size Right-Size Pack at home first.
Choose your ring pessary
Frequently asked questions
Why doesn't SciMed sell Gellhorn or Cube pessaries?
Both require provider fitting and are used for advanced prolapse. Direct-to-patient sale isn't clinically appropriate. We focus on ring pessaries where at-home patient management is the standard of care.
My doctor said I need a Gellhorn but I want to try a ring first — is that safe?
Try the ring only if your prolapse stage is I-II. If your doctor specified Gellhorn, they likely see anatomy that won't hold a ring — and a fallen-out pessary offers zero benefit. Follow their advice.
What's the difference between Ring With Support and Ring Without Support?
With Support adds a silicone membrane for bladder support (cystocele, SUI). Without Support is a simple open ring for prolapse alone. See our With Support guide or Without Support guide.
Are Gellhorn and Cube available anywhere online without prescription?
Some sellers list them without Rx, but professional fitting is strongly recommended for both. Wearing the wrong Gellhorn or Cube size can cause tissue damage.