The elderly population, especially 85 years or older, is experiencing an increasing rate of growth (1). As a result, the number of patients presenting for treatment of pelvic organ prolapse, including those who do not desire to maintain sexual function, is also increasing (2,3). Many of these patients will not be sexually active for a variety of reasons and restorative reconstructive surgery may not be desired. For these patients, the pelvic reconstructive surgeon should be comfortable discussing the option of obliterative vaginal procedures. Shorter operative time and less surgical risk are the advantages of this approach over traditional vaginal reconstructive procedures (4). The obliterative procedures for severe prolapse are total colpocleisis (i.e., colpectomy) and partial colpocleisis, with or without levator myorrhaphy and high perineorrhaphy. When a colpocleisis is not technically feasible, a constricting anterior and posterior colporrhaphy with levator myorrhaphy and high perineorrhaphy may be considered.

Partial colpocleisis approximates denuded portions of the anterior and posterior vagina; therefore, the uterus may be left in place as lateral channels are formed from which cervical drainage or blood can escape. Since a total colpocleisis involves complete denudation and does not leave drainage channels, concurrent or previous hysterectomy is necessary. Either way, potential colpocleisis candidates should be counseled regarding the loss of a sexually functioning vagina.

Throughout history, women have endured severe pelvic organ prolapse. Ineffective methods of correction that were attempted included vaginal packing, crude pessaries, and instillation of caustic materials. Some women were even hung upside down to invert the prolapse back into the pelvis (5). Initial attempts at surgical management involved amputation of the prolapsing segments or closure of the vaginal introitus (6), with unsatisfactory results.

The idea to surgically obliterate severe prolapse is credited to Gerardin, who suggested suturing surgically denuded anterior and posterior vaginal walls together (7). Even though he wrote about this technique in 1823, he never attempted the procedure. Subsequently, the first known procedure was performed in 1867 by Neugebauer, who waited until 1881 to publish his technique (8). Neugebauer obliterated the vagina by denuding 6 × 3-cm anterior and posterior areas near the introitus and suturing them together. Leon Le Fort’s technique was actually published first in 1877 (9). Le Fort’s modifications differed in that longer and narrower areas of denudation were performed and that a colpoperineoplasty was performed 8 days after the colpocleisis to address the widened genital hiatus. In general, a partial colpocleisis is referred to as a Le Fort colpocleisis, but a less common eponym is the Neugebauer-Le Fort procedure. Edebohls, in 1901, was the first to report performing a total colpocleisis with levator myorrhaphy following hysterectomy (i.e., panhysterocolpectomy) (10,11). His report was followed by several case series that had comparable results to the partial colpocleisis-type procedures (12). Even though adoption of the colpocleisis procedure was slow in the United States, in 1880, Berlin reported three cases (one of which failed) to the New England Hospital (13). This failure was blamed on lack of a concurrent perineorrhaphy being performed.

In the attempt to make colpocleisis more acceptable, early modifications were directed at reducing the risk of recurrence or the incidence of postoperative urinary incontinence, which was as high as 25% (14) and attributed to scarring from a
distal dissection and pulling down of the bladder neck. An early example to increase the robustness of the repair was creating a wider septum, as reported by Wyatt in 1912 (15). Other authors addressed postoperative urinary incontinence by sparing the distal vagina near the urethra or by supporting the bladder neck with a high perineorrhaphy (6,15, 16, 17, 18, 19). Goodall and Power in 1937 tried to preserve sexual function by creating a triangular septum higher in the vagina that would allow for intercourse and potentially less stress urinary incontinence (20).

The classic example of a candidate for colpocleisis is an older, sexually inactive patient who has medical comorbidities that make a quick and relatively noninvasive procedure attractive. Further, she has either declined pessary or had unsatisfactory results. Sometimes this description includes patients who may have a spouse. Therefore, the patient and her partner need to be counseled that intercourse is not possible after colpocleisis, even if her quality of life improves. Candidates should also be counseled that reported satisfaction rates are greater than 85% and regret rates are less than 11% (19,21, 22, 23, 24).