Colpocleisis

What is colpocleisis?

Colpocleisis is a type of surgery used to treat pelvic organ prolapse (POP). Your pelvic organs include your vagina, uterus, urethra, bladder and rectum. Muscles and connective tissue in what’s known as your pelvic floor hold these organs in place. Over time, these muscles and connective tissue can weaken, causing one or more of these organs to sag. Sometimes, they get pulled so far down that they stick out through your vagina (prolapse).

There are two main types of surgery used to treat POP: reconstructive procedures and obliterative procedures. Colpocleisis is an obliterative procedure.

• Reconstructive procedures: Reconstructive POP surgery requires incisions (cuts) into your vagina or abdomen. Your healthcare provider places your organs in their original positions before the prolapse so that they no longer sag.
• Obliterative procedures: Obliterative POP surgery doesn't require incisions into your abdomen. Your healthcare provider performs surgery to place your pelvic organs back into your pelvic cavity and uses dissolvable sutures to close the walls of your vagina to prevent POP recurrence (return).

Is colpocleisis a major surgery?

Yes. But colpocleisis isn’t as invasive or time-intensive as reconstructive surgery. Colpocleisis takes about an hour. Reconstruction surgery can take up to five hours.

What is the difference between a partial (Le Fort) colpocleisis and a total colpocleisis?

With colpocleisis, your provider sews together your vaginal walls so that your pelvic organs no longer extend outside your body. What happens during surgery depends on whether your provider recommends a partial colpocleisis or a total colpocleisis.

• Total colpocleisis (complete colpocleisis): The front and back walls of your vagina are sewn together. Your vaginal canal is shortened so that sagging pelvic organs are pushed back into place.
• Partial colpocleisis (Le Fort colpocleisis): The procedure shortens your vaginal canal, as with a total colpocleisis. But, it creates two small tunnels within your vaginal canal that allow fluids from your uterus to drain from your body through your vagina. Le Fort colpocleisis is the best option for people who still have their uteruses.

Who needs to have colpocleisis?

You might get a colpocleisis if you need surgery to correct POP, but you’re not a good candidate for reconstructive surgery. Colpocleisis may be an option if:

• You no longer plan to have vaginal intercourse. Your vaginal canal following colpocleisis will be too short for intercourse.
• Your body can’t tolerate reconstructive surgery. Colpocleisis is a good option if you have health conditions that prevent you from having reconstructive surgery.
• Your POP is too severe for conservative treatments. When POP is mild, pelvic floor strengthening exercises, like Kegel exercises, can help pull your organs back into place. Medical devices, like a vaginal pessary, can help, too. Pelvic organs that bulge outside of your vagina require surgery.

How common is colpocleisis?

POP is common among people with female reproductive anatomy who are in their 80s and 90s. People with male reproductive anatomy can have pelvic floor disorders. But the prostate gland usually prevents organs from extending outside the body.

Research estimates that about 20% of cisgender women — people who are designated female at birth (DFAB) and who identify as women — will need surgery for either POP or incontinence by age 80. A colpocleisis effectively treats POP, often without complications.

What happens before a colpocleisis?

Your healthcare provider will assess your health to be sure that you’re a good candidate for surgery. Also, they’ll discuss with you how having a colpocleisis may change your sex life and your options for diagnostic screenings.

After colpocleisis, your vaginal canal will be too short for intercourse. Also, many of the diagnostic procedures used to detect diseases affecting your reproductive organs won’t be possible. Many of these procedures require access to your vagina and cervix. It’s important to understand these changes and agree to them before having surgery.

Health assessment

As part of your health assessment, your provider may:

• Do blood tests.
• Do an electrocardiogram (EKG) to check for signs of heart disease.
• Review your medical history, including what medications you’re taking.
• Take a pelvic floor history (ask about incontinence issues, if you’re having trouble emptying your bladder or bowels).
• Assess your POP symptoms (ask if your vagina feels like it’s bulging, if you’ve noticed any skin irritation or bleeding, and if you’re feeling pressure in your pelvis).

Your provider may offer instructions for diet and exercise to prepare you for surgery. These recommendations may include advice to quit smoking four to six weeks before your procedure. Smoking can slow the healing process and increase your risk of complications.

Preliminary diagnostic procedures

Diagnostic procedures that require access to your vaginal canal will no longer be an option following a colpocleisis. Depending on your risk of developing conditions following surgery — like stress urinary incontinence (SUI), cervical cancer or uterine cancer — your provider may recommend surgeries to prevent these conditions. For instance, your provider may recommend a hysterectomy (remove your uterus) if you’re at high risk for uterine cancer.

Your provider may conduct tests or procedures that require access to your vaginal canal before your colpocleisis to check your health. These procedures may include:

• Pap smear.
• Cervical cytology.
• Endometrial biopsy.
• Transvaginal ultrasound.

Talk to your provider about how having a colpocleisis relates to your disease risk. In some cases, you may need preventive surgery. In other instances, preventive surgeries may create unnecessary risks.

What happens during a colpocleisis?

A colpocleisis takes about an hour.

During the procedure, your provider will stitch together tissue from your vaginal walls to correct your prolapse. Your provider will:

• Administer either general anesthesia (you’re asleep) or regional anesthesia (you’re awake) so that you don’t feel any pain.
• Insert a catheter into your bladder to help you pee during the procedure.
• Place compression stockings on your legs to prevent clots during your colpocleisis.
• Remove the thin vaginal lining from the vaginal muscle. How much skin gets removed depends on whether you’re having a Le Fort or a total colpocleisis.
• Stitch the walls of your vagina together, using dissolvable sutures.

After your surgery, your vaginal canal will be much shorter (reduced from about 4 inches to 1 inch), and the opening of your vagina will be much smaller. The outside of your vagina and your external genitalia (vulva) will look the same.

What happens after a colpocleisis?

You may leave the hospital on the day of your surgery, or you may stay in the hospital overnight. Before you go, your provider will determine whether to remove your catheter or if you’ll need it for a few days while you recover. Your provider can teach you how to use a catheter if needed. Plan to have someone drive you home from the hospital.

Expect to have a follow-up appointment with your provider within two to four weeks following your surgery. You may notice some unpleasant symptoms over several days, weeks and months that are all part of the healing process.

• Vaginal bleeding and pain in your perineum (the delicate skin between your anus and vagina): These symptoms usually improve within a week. Taking over-the-counter NSAIDs, like aspirin or ibuprofen, can ease your pain.
• Yellowish vaginal discharge: The discharge is just your stitches dissolving. It will take anywhere from six to eight weeks for your stitches to heal completely.
• Trouble emptying your bladder (urinary retention): You may have difficulty peeing without a catheter after surgery, but the situation should improve over time.
• Constipation. You may need to use stool softeners or laxatives for a while after your surgery.

What are the advantages of colpocleisis?

Colpocleisis has excellent success rates. A colpocleisis cures or significantly improves symptoms associated with POP in 90% to 100% of cases. Advantages include:

• Short operating time: A colpocleisis is less time-intensive and invasive than reconstructive surgery.
• Improved urinary retention: Urinary retention (the ability to empty your bladder) improves in 90% of colpocleisis cases.
• Low risk of a prolapse returning: Colpocleisis treats POP and prevents future instances of prolapse.

Although vaginal intercourse will no longer be an option, you can still have a healthy sex life. Clitoral stimulation and orgasms are possible following a colpocleisis.

What are the risks or complications of colpocleisis?

Colpocleisis rarely involves complications. Most people who receive this procedure are in their 80s or 90s, but age isn’t a risk factor for complications. Instead, your overall health status determines risk.

The risks of colpocleisis are similar to typical risks associated with surgery:

• Blood clots.
• Infection.
• Bleeding or injury to a muscle or nerve during surgery.

Around 13% to 65% of people who receive surgery to correct POP develop stress urinary continence (SUI). Talk with your provider about your risk of developing SUI after surgery. Your provider can advise you on whether you should have surgery to prevent this condition.

What is the recovery time?

Expect to feel tired and sore within the first two weeks following surgery. Within a few days to a few weeks, you may feel well enough to begin doing everyday activities, like walking and driving. It may take up to six weeks before you’ve healed enough to go back to work.

While you’re healing, avoid intense exercise and heavy lifting. It’s also a good idea to stock up on groceries or complete any errands before surgery so that you allow yourself maximum recovery time with few interruptions.

When should I see my healthcare provider?

Contact your provider immediately if you notice symptoms of infection or signs that your incision isn’t healing. Call if you notice:

• A fever.
• Abdominal pain.
• Trouble peeing.
• Foul-smelling vaginal discharge.
• Worsening pain from your incision.
• Heavy bleeding from your incision.
• Bleeding from your incision that won’t stop.

Is Colpocleisis reversible?

No. Weigh the pros and cons of colpocleisis with your provider beforehand to ensure that this surgery is right for you.

How long does colpocleisis surgery take?

A colpocleisis surgery takes about an hour. It may take longer if you have another procedure with it, like a hysterectomy or surgery to prevent stress urinary incontinence.

A note from Cleveland Clinic

Have an honest conversation with your provider about the benefits of colpocleisis as you consider options to treat your POP. Most people who have the surgery report feeling satisfied with the results. The surgery can allow you to experience relief from POP symptoms without going through more invasive reconstructive surgery. If the lack of access to a vaginal canal post-surgery poses risks, your provider can talk you through options to address those concerns, too.