A sacrospinous ligament suspension is a vaginal surgery that is used to re-attach the “top” or “apex” of the vagina when it has come down. Normally, the vagina is held in place by the combined action of ligaments (sometimes called “fascias”) and muscles. The primary problem occurs in women with vaginal prolapse when the tissues fail that normally hold the top of the vagina in place. This operation attaches the vagina to the sacrospinous ligament through the vagina. An incision is made at the top of the vagina – not through the abdomen. The surgeon then reaches up to the ligament, puts four stitches into it, and then uses these stitches to tie the top of the vagina up. This pulls up the vagina to a normal position. If the front wall is still dropped, then an anterior repair is done; and if the back wall is falling, a posterior repair also is done. During the operation, the surgeon will correct any abnormal areas. This is a great option in patients who want to preserve their uterus or who have already had a hysterectomy and want a vaginal approach (without an abdominal incision) for vaginal support.