The Gellhorn pessary must be folded in half with lubricant on the leading edge for ease of insertion. Once inserted, the pessary expands behind the pubic symphysis, and expands and rests against the edge of the prolapse, forming suction, says Jones and Harmanli for Reviews in Obstetrics and Gynecology.
The Gellhorn is typically used for advanced-stage prolapse or for patients who are no longer sexually active. This pessary cannot be removed by a patient. It is removed by grasping the knob, usually with ring forceps, as the concave end is rotated to release suction. Then, the pessary is pulled down, folded and removed, reports Jones and Harmanli.
Pessaries are often used as they present an alternative to surgical repair for pelvic organ prolapse. Pessaries are options for patients who are poor surgical candidates, do not desire surgery or have not completed childbearing, according to Jones and Harmanli. Long-term use of a pessary for patients with pelvic organ prolapse and stress urinary incontinence is safe and effective. While serious side effects are infrequent, insertion and removal of most pessary types are a challenge for patients. Some side effects include vaginal discharge and odor.
Pelvic organ prolapse is the most common reason for pessary use. Pessaries are also used for patients with stress incontinence worsened by physical activity, explains Jones and Harmanli. Pessaries can simulate postsurgical conditions and aid in patient expectation for women with pelvic pain, back pain and pressure potentially due to pelvic organ prolapse. Pessary use has few contradictions, allowing physicians to present the option to most patients.