Crossover Design
Each woman used both pessaries for 3 months each in random order, serving as her own control. Of 134 enrolled, 85 completed both arms. Data available: n=94 for ring with support, n=99 for Gellhorn.
Pessary A · n = 94 evaluable
Ring with Support
Ring pessary with support diaphragm
Pessary B · n = 99 evaluable
Gellhorn
Gellhorn pessary with concave disc and stem
Population
61 yrMean age
82%Postmenopausal
Stage IIIMedian POP-Q
51%Anterior
34%Apical
10%Posterior
Key Result
No Clinically Significant Difference Between Pessaries
Both ring with support and Gellhorn produced statistically and clinically significant improvements in PFDI and PFIQ symptom scales. Between-pessary comparisons showed no meaningful differences on any subscale.
Outcome Summary: Between-Pessary Comparisons
| Scale |
Ring Improved? |
Gellhorn Improved? |
P (between) |
Difference |
| POPDI |
Yes |
Yes |
0.99 |
NS |
| UDI |
Yes |
Yes |
0.62 |
NS |
| CRADI |
Yes |
Yes |
0.91 |
NS |
| POPIQ |
— |
— |
0.29 |
NS |
| UIQ |
— |
— |
0.74 |
NS |
| CRAIQ |
— |
— |
0.29 |
NS |
Satisfaction Analysis
VAS satisfaction was
bimodal. For the
Gellhorn, high satisfaction (≥8/10) was associated with symptom improvement (ΔUDI P=.001, ΔPOPDI P=.001, ΔCRADI P=.012). For the
ring with support, high satisfaction was
not significantly associated with symptom improvement — driven instead by ease of use and comfort.
Fitting & Completion Data
8% could not be fitted with at least one pessary;
4% could not be fitted with either. Refitting required:
28% ring,
33% Gellhorn. Younger women and non-white women were less likely to complete the study.
Clinical Bottom Line
Ring with support and Gellhorn pessaries are equally effective for relieving POP symptoms — especially protrusion and voiding dysfunction. Clinician and patient preference should guide pessary type selection. The Gellhorn may provide more symptom-correlated satisfaction, while ring satisfaction is driven more by ease of use.