Vaginal surgery
The repair is reached through the vagina. Many wall repairs, ligament suspensions and vaginal hysterectomies use this route, without abdominal incisions.
PELVIC SUPPORT · YOUR OPTIONS
Prolapse surgery
The aim is to ease the bulge and help you live more comfortably. The right repair depends on which areas need support, your health and what matters to you.
On this page
START WITH YOUR GOALS
Is surgery right for me?
Surgery may help when a bulge affects comfort, activity or daily life, and you prefer a repair after discussing the alternatives. You do not have to try every other treatment first. Monitoring, pelvic floor physiotherapy and a pessary remain valid choices.
We assess support and bladder, bowel and sexual symptoms together. Repair often improves the bulge; urgency, constipation or pelvic pain may need separate treatment. Tell me about previous operations and future pregnancy plans before choosing a repair.
What needs support?
Front wallThe support between the bladder and vagina.
Back wallThe support between the rectum and vagina, sometimes including the tissue at the vaginal opening.
Top of the vaginaThe uterus and cervix, or the vaginal vault after hysterectomy. This is called apical support.
More than one area may need repair in the same operation. See the prolapse anatomy illustrations.
UNDERSTANDING THE REPAIRS
Different ways to restore support.
Each summary explains what the repair does. Open it for a closer look. Several techniques can be combined; these are options to discuss at your consultation.
The illustrations show the anatomy and repair in more detail. Select an IUGA image for a larger view.
01Front or back vaginal-wall repairReinforces the supporting tissue beneath the vaginal lining.
Anterior repair supports the bladder side. Posterior repair supports the bowel side; a perineal-body repair may also support the vaginal opening. These are usually vaginal operations using your own tissues.
Back-wall repair may help stool trapping caused by a rectocele, but does not treat every cause of constipation. Scarring or pain with vaginal penetration can occur. Top support is assessed too.
02Support using stitches and your own ligamentsLifts the uterus or vaginal vault without a mesh graft.
Options include uterosacral ligament suspension or plication and sacrospinous fixation. The attachment and access route vary. Some preserve the uterus; others support the vault after hysterectomy.
These avoid a synthetic graft, though stitches may be permanent. Recurrence remains possible. Particular risks depend on the attachment: for example, ureter injury or obstruction with uterosacral repair, or buttock pain with sacrospinous fixation.
03Hysterectomy with a support repairCombines removal of all or part of the uterus with a support repair.
A subtotal hysterectomy removes the body of the uterus and keeps the cervix (the neck of the womb). A total hysterectomy removes both. Neither operation alone reconstructs all the weakened support: we also plan the support repair and any front or back repair needed.
The operation may be vaginal or abdominal, including selected laparoscopic or robotic approaches. Reasons to remove the uterus can include uterine disease or your preference after discussing preservation. Removal of the ovaries is a separate decision.
04Sacrocolpopexy & sacrohysteropexyConnects support for the vagina, cervix or uterus to a ligament over the sacrum.
A graft, commonly permanent synthetic mesh, connects support for the vagina or cervix to a ligament over the sacrum. Sacrocolpopexy can support the vaginal vault after total hysterectomy, or form part of a repair with subtotal hysterectomy. Sacrohysteropexy retains and supports the whole uterus.
My usual approach when combining hysterectomy with sacrocolpopexy is subtotal hysterectomy, keeping the cervix, when clinically appropriate. Reducing the risk of vaginal mesh exposure is one reason for this choice. The plan also takes account of bleeding, cervical screening and any uterine or cervical disease.
Conventional laparoscopy or robotic assistance may be suitable. Open access is sometimes needed. Sacrocolpopexy has good comparative evidence for vault prolapse, but graft risks and the extent of surgery matter too.
I also offer selected sacrocolpopexy using your own fascia, described below. Evidence for one material cannot simply be applied to another.
05PectopexyUses attachment points on both sides of the pelvis.
I offer pectopexy in selected circumstances. It supports the uterus or vaginal apex using the pectineal ligaments on the right and left, rather than a sacral attachment. It commonly uses a synthetic mesh graft.
Anatomy, previous surgery and the proposed graft influence the choice. Long-term comparative evidence is less established than for mesh sacrocolpopexy. It still carries surgical and, when mesh is used, implant risks.
06Sacrocolpopexy using your own fasciaUses a graft of your connective tissue instead of synthetic mesh.
I offer this option for selected patients. Fascia is a strong layer of connective tissue harvested from elsewhere in your body and used to support the vagina towards the sacrum.
It avoids a synthetic mesh graft, but requires tissue harvesting, with additional wound, pain and donor-site risks. Stitches may still be permanent. Available studies are smaller and less extensive than the evidence for synthetic mesh sacrocolpopexy; equal long-term durability cannot be assumed. We discuss the donor site, technique and alternatives individually.
07Colpocleisis — vaginal closureA selected option when future vaginal penetration is not wanted.
Closing most or all of the vaginal canal supports the prolapse with a less extensive operation than some reconstructive repairs. This can be a useful option when health risks or personal priorities favour it.
It permanently prevents vaginal penetrative intercourse. Other forms of intimacy remain possible. If the uterus is retained, bleeding and relevant uterine or cervical concerns need assessment beforehand because later access is restricted. We discuss urinary symptoms and future preferences carefully before consent.
HOW WE REACH THE REPAIR
Vaginal, laparoscopic or robotic?
The access route is one part of the plan. It does not tell you whether mesh is used, whether the uterus is removed or which support is repaired.
Conventional laparoscopy
A camera and instruments pass through small abdominal incisions. The surgeon works directly with the instruments to perform the planned repair.
Robotic-assisted laparoscopy
The surgeon controls a camera and articulated instruments from a console. The robot does not operate independently. It still requires abdominal incisions and anaesthesia.
Robotic surgery at Life Kingsbury Hospital
I offer da Vinci robotic-assisted prolapse repair, including selected sacrocolpopexy, hysteropexy and ligament-support procedures. The choice depends on your anatomy, previous surgery, health and goals. Robotic assistance does not guarantee a better result or faster recovery than other suitable approaches.
We also discuss costs and medical-aid authorisation. Occasionally an open abdominal incision is the safer planned approach, or becomes necessary during surgery.
SEPARATE DECISIONS
Keeping the uterus. Planning bladder care.
Uterus & ovaries
Prolapse does not automatically require hysterectomy. Uterine preservation may be appropriate after considering bleeding, cervical screening, uterine findings and your preferences. If we keep the cervix, either with the uterus or after subtotal hysterectomy, continue cervical screening as advised. Light cyclical spotting can sometimes persist after subtotal hysterectomy; report new or unexpected bleeding.
Hysterectomy does not automatically mean removing the ovaries. Removing both ovaries before natural menopause causes surgical menopause; that decision needs its own discussion.
Bladder symptoms & future pregnancy
Leakage on coughing or exercise can become apparent once a prolapse is lifted. We assess this before surgery and discuss whether continence treatment should be added or considered later. A sling is not needed for everyone.
If you may want a future pregnancy, tell me early. Pregnancy and birth can affect a repair, and surgery is often deferred. Preserving the uterus alone does not settle pregnancy planning.
WHAT PROVIDES THE SUPPORT?
Your tissues, mesh or an own-fascia graft.
Native tissue & stitches
Your existing support is reinforced or reattached. No mesh graft is added, but some stitches may remain permanently.
Synthetic mesh
A manufactured implant provides support. It remains in the body and has specific long-term risks, including exposure through the vaginal lining.
Your own fascia
A strip of your connective tissue acts as the graft. It avoids synthetic mesh but adds a tissue-harvest site and its own risks.
Why has mesh been controversial?
Serious complications with vaginal prolapse mesh prompted patient advocacy, reviews and regulatory action. In 2019, the US FDA stopped sales of mesh products intended for transvaginal prolapse repair. That action was specific to those US products, not a ban on every mesh operation or a statement of South African regulation.
Mesh placed through the abdomen for prolapse and midurethral slings for stress leakage differ in placement and purpose. Abdominal placement still carries risks, including vaginal exposure, infection and pain; treatment can require further surgery and may not resolve every symptom. We discuss the particular implant, alternatives and follow-up before consent.
Keeping the cervix & mesh exposure
Mesh exposure means that mesh becomes visible through the vaginal lining. Keeping the cervix during a subtotal hysterectomy is one way of aiming to reduce this risk when hysterectomy is combined with sacrocolpopexy.
A review combining studies found lower exposure rates with subtotal than total hysterectomy. More recent comparative studies have not all found a difference. The mesh, surgical technique, tissue healing and length of follow-up also matter, and keeping the cervix does not remove the risk.
We discuss the evidence that best matches your proposed repair and your own risk factors. Exposure can develop years later; it is not the same as needing mesh removal, although some women need treatment or further surgery.
Review comparing subtotal and total hysterectomy · More recent comparative study.
A BALANCED DECISION
Benefits, risks & recurrence.
What improvement means
Relief from a bothersome bulge and better daily function are useful goals. A small change seen on examination, feeling a recurrent bulge and needing another operation are different outcomes.
Comparative trials in women with vault prolapse support a lower recurrence risk after sacrocolpopexy than after some vaginal repairs. This does not establish the best operation for every woman, or equal results for every material and technique. Prolapse can return in the repaired area or another compartment.
Risks to discuss for your repair
These include bleeding, infection, blood clots, anaesthetic problems and injury to the bladder, bowel, ureters or blood vessels. Some complications require another procedure.
Temporary difficulty emptying the bladder, new leakage, pain with vaginal penetration, persistent pain or altered bowel function can occur. Mesh, ligament attachments and fascia harvesting add different risks. Your consent discussion should address the exact operation and your individual circumstances.
PREPARING & RECOVERING
A practical plan for getting home.
Before surgery
Bring a medicines and supplements list, allergies and previous operation details. Agree on your fasting and medication plan with the team. Arrange transport, help at home and time away from work; confirm costs and authorisation.
In hospital
The team manages pain, nausea and clot prevention and helps you start walking. A catheter may be needed. Before discharge, confirm how bladder emptying will be checked, your bowel plan and whom to call if you are worried.
At home & follow-up
Build up short walks and daily tasks as comfort allows. Take prescribed medicines and keep stools soft. Check your follow-up date, catheter plan if relevant and when any tissue results will be discussed.
Work, lifting, exercise & driving
Recovery depends on the repair, your health and the demands of the activity. Prolonged bed rest is unhelpful. Gradually increase activity, with an individual plan for heavy work, lifting and exercise.
A trial of selected vaginal and laparoscopic apical repairs found similar outcomes at three months with a quicker return to activity. It does not settle every operation or long-term outcome. Follow your own discharge advice and ask for clarification if it is unclear.
Drive only when you can sit, move and perform an emergency stop comfortably, are clear of sedating medicines and meet your insurer’s requirements. A phased return to work may help.
Vaginal healing, swimming & intimacy
Small abdominal incisions do not mean the internal repair has healed. Wait for the team’s advice before vaginal penetration, tampons or inserting anything into the vagina; this is often around six weeks but depends on healing and the procedure. Colpocleisis permanently prevents vaginal penetration.
Swimming should wait until wounds are healed and bleeding or discharge has settled, following your discharge instructions. When penetration is appropriate again, go gently and stop if it hurts. Dryness or persistent discomfort deserves review.
IF SOMETHING DOES NOT FEEL RIGHT
Troubleshooting after surgery.
Passing urine is difficult, or a catheter is not draining
Some women temporarily need a catheter while swelling settles. Follow the removal and bladder-check plan. Seek same-day advice for a weak stream, incomplete emptying, burning or a catheter that stops draining. A painful full bladder or inability to pass urine needs urgent assessment now; do not force fluids while waiting.
I am constipated
Use the prescribed stool-softening plan, drink normally and walk regularly. Avoid prolonged straining. Contact the team if this is not helping. A swollen abdomen with vomiting, worsening pain or inability to pass wind needs urgent assessment.
I have spotting, discharge or discomfort
Light spotting or discharge and discomfort that steadily improves can occur during healing. Use pads to monitor it. Increasing bleeding, offensive discharge, fever or worsening pain needs review; heavy bleeding or feeling faint needs emergency care.
I notice leakage, pain with sex or a bulge again
Arrange review rather than assuming the repair has failed. Leakage may become apparent after support is restored; discomfort or a bulge needs examination to distinguish healing changes from a problem. Persistent pain with penetration should be assessed. Use the urgent advice above if symptoms are sudden, severe or accompanied by bleeding or urinary retention.
YOUR CONSULTATION
Questions worth bringing with you.
- Which areas need support, and what symptoms is the repair likely to improve?
- Can I keep my uterus? Which material and access route are you recommending, and why?
- What are my alternatives, individual risks and chances of needing further treatment?
- What help, recovery time, follow-up and costs should I plan for?
YOUR NEXT STEP
A repair planned around you.
Bring your priorities, previous operation details and questions. We will work through the options together and agree on a plan.
General information to support an individual consultation. Illustrations show examples; the exact repair varies with your anatomy and treatment plan. Updated .
Anatomical repair illustrations: International Urogynecological Association (IUGA) patient information leaflets, with original illustrator credits retained.
Sources & further reading
- NICE: prolapse and continence treatment choices
- Cochrane 2023: surgery for apical prolapse · 2024 vault-prolapse trial
- FDA: distinctions between prolapse mesh procedures
- 2022 review: subtotal versus total hysterectomy and mesh exposure · 2024 comparative mesh-exposure study
- NHS: subtotal and total hysterectomy
- Pectopexy comparative study · Own-fascia sacrocolpopexy cohort
- IUGA: colpocleisis
- Trial of activity after prolapse surgery · Cochrane 2025: perioperative care
- RCOG: recovering after pelvic floor repair · Cochrane: prolapse surgery with or without continence treatment