Sacrospinous fixation (SSF) surgery for vaginal prolapse

Sacrospinous fixation (SSF) is a surgical procedure used to treat vaginal vault prolapse—a condition where the top of the vagina descends after a hysterectomy or due to weakened pelvic floor support. It is one of several surgical options available to restore vaginal support and relieve symptoms of pelvic organ prolapse.

SSF offers a vaginal, minimally invasive approach with good long-term outcomes, particularly suited to women seeking uterine-sparing or post-hysterectomy repair.

What is sacrospinous fixation and how is it performed?

Sacrospinous fixation involves attaching the top of the vagina (vaginal vault) to a strong ligament deep within the pelvis called the sacrospinous ligament. This ligament connects the sacrum (base of the spine) to the pelvic bones and provides reliable support.

The procedure is carried out through the vagina, typically under spinal or general anaesthesia. The surgeon uses stitches to secure the vaginal vault to the ligament, often on the right side of the pelvis, without the need for abdominal incisions or mesh implants.

When is SSF recommended?

SSF may be offered to women experiencing:

• Vaginal vault prolapse after a hysterectomy
• Significant vaginal bulging or pressure
• Discomfort or difficulty with walking, sitting, or sexual activity due to prolapse
• Recurrence of prolapse after previous pelvic floor repair

It can be performed alone or alongside other procedures such as anterior or posterior vaginal wall repair.

What are the benefits of SSF?

This procedure has several advantages:

• Vaginal approach: Avoids abdominal surgery and typically allows faster recovery
• Effective support: Reduces prolapse symptoms and improves vaginal anatomy
• No mesh: Uses the body’s own tissues, reducing the risk of mesh-related complications
• Durability: Offers good long-term success rates for restoring vaginal support

Are there any risks associated with SSF?

As with any surgery, SSF carries potential risks. These include:

• Bleeding or infection
• Injury to nearby structures, such as the rectum, bladder or nerves
• Pain or numbness in the buttock or leg (usually temporary and due to nerve proximity)
• Difficulty emptying the bladder
• Prolapse recurrence in another part of the vagina (e.g. anterior or posterior wall)
• Shortening or narrowing of the vagina, which may affect sexual function in some cases

Pudendal nerve injury is a potential risk during sacrospinous ligament fixation (SSF), with an estimated incidence of 1 to 2 per cent. The pudendal nerve, which controls sensation and function in the perineum, is closely related to the sacrospinous ligament, and the sutures used in SSF can potentially cause nerve entrapment or trauma. This can lead to pain, numbness, and potentially other issues in the gluteal and perineal areas.

These risks are relatively uncommon and are discussed with patients during preoperative planning.

What is the recovery like after SSF?

Recovery from SSF surgery is generally quicker than with abdominal procedures. Patients are usually advised to:

• Stay in hospital for one to two days
• Avoid heavy lifting and sexual activity for 6 weeks
• Resume light daily activities as comfort allows
• Follow up with their gynaecologist to monitor healing

Is SSF an effective long-term solution for prolapse?

Yes—SSF has been shown to provide effective, long-lasting support for vaginal vault prolapse with high patient satisfaction. It is especially useful for those wishing to avoid mesh or abdominal surgery. As part of a personalised treatment plan, SSF can restore comfort, function, and confidence in women affected by pelvic organ prolapse.