What is colpocleisis?
Colpocleisis, also called vaginal closure surgery, is a procedure used to address pelvic organ prolapse (POP). This procedure corrects the prolapse by shortening the vaginal length and narrowing the vaginal opening to prevent tissue from prolapsing.
Your pelvic organs include the vagina, uterus, urethra, bladder and rectum. These organs are supported by muscles and connective tissue in what’s called the pelvic floor. Over time, these muscles and connective tissue can weaken, causing one or more of the organs to sag. In some cases, they may be pulled down so far that they protrude through the vagina, leading to a condition known as prolapse.
Having colpocleisis can resolve many uncomfortable symptoms of prolapse, including organs that protrude from the vagina, pelvic pressure and pain. However, if you would like to continue having sex or vaginal intercourse, you can talk with your surgeon about alternatives that support the pelvic organs but do not require total vaginal closure.
Types of colpocleisis surgery
Colpocleisis is considered an obliterative surgery for pelvic organ prolapse, which means it relieves your symptoms by completely closing the vaginal canal. Other types of pelvic organ prolapse surgery, such as colporrhaphy, are considered reconstructive procedures because they help your surgeon restore your normal anatomy.
There are two different types of colpocleisis: partial and total. In both cases, the result is a shorter vaginal canal. You still have a vaginal opening, and your vagina will look the same on the outside as it did before the procedure.
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Partial colpocleisis
Also called Le Fort colpocleisis (named after the man who first performed the procedure), a partial colpocleisis is performed on people who still have a uterus. The vaginal walls are sewn together, but the surgeon leaves two small tunnels to allow uterine or cervical fluids to drain.
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Total colpocleisis
A total colpocleisis, also known as a complete colpocleisis, is performed on people without a uterus or may be performed along with a hysterectomy. The surgeon completely closes the vagina because there is no need to allow space for uterine or cervical fluids.
Why might I need colpocleisis surgery?
You might consider colpocleisis if you need surgery to correct pelvic organ prolapse (POP) but aren’t a good candidate for reconstructive surgery. Colpocleisis could be an option if:
- You no longer plan to have vaginal intercourse, as the vaginal canal will be too short for intercourse after the procedure. Your health conditions make reconstructive surgery too risky. Colpocleisis is a safer alternative for those who cannot tolerate more invasive surgery.
- Your POP is too severe for conservative treatments. While mild POP can be managed with pelvic floor exercises, like Kegels, or medical devices like a vaginal pessary, more severe cases, especially those where organs protrude outside the vagina, require surgery.
How to prepare for a colpocleisis
Colpocleisis closes off access to your pelvic organs, including your cervix and uterus. That means your providers can’t perform traditional screenings or diagnostic tests for conditions such as cervical or uterine cancer.
Before you and your provider decide if a colpocleisis is right for you, you may need specific tests to determine whether it’s safe to close off access to your uterus and cervix.
Those procedures may include:
- A Pap test
- Uterine or endometrial biopsy
- Pelvic ultrasound
If you have a high risk for cancer, you may need a preventive procedure to lower your risk.
Your provider may also talk to you about whether you currently experience urinary incontinence and, if you do, order urodynamic testing. Some people benefit from having surgery to correct incontinence during a colpocleisis.
The colpocleisis procedure
Your surgeon will perform your colpocleisis through your vagina. You will not need a large incision in your abdomen, which means recovery is generally faster than with other types of surgery and you have a lower risk of complications.
Colpocleisis can be performed as an outpatient surgery, meaning you go home the same day or may need to stay overnight in the hospital. In both cases, you will be under anesthesia. You may have general anesthesia (you will be asleep) or spinal anesthesia that numbs your body from the waist down but allows you to stay awake.
You will need to have someone available to drive you home after your procedure.
Before the procedure
You will receive instructions from your care team about what to do on the day of your surgery. Your team will tell you when to stop eating and drinking and whether to take your medications on the day of your procedure.
During the procedure
The procedure will begin with you receiving anesthesia. Once it takes effect, your surgeon will place a catheter into your bladder and start operating.
First, the surgeon removes the tissue lining your vagina. Next, they use dissolving sutures to attach the front (anterior) wall to the back (posterior) wall. With the walls of the vagina attached, your pelvic organs are pushed back into place. They won’t be able to fall or slip out of place in the future.
Based on other pelvic floor conditions you may have, your surgeon may use a small camera to inspect your bladder to ensure it wasn’t harmed during the procedure.
A colpocleisis takes about an hour but may last longer if your surgeon performs other procedures at the same time.
After the procedure
You’ll be moved to a recovery room while the anesthesia wears off. You will still have the catheter in your bladder. Your surgeon will let you go home when you can urinate on your own or they decide you need to have the catheter for a few days while you recover.
You may notice white or yellow vaginal discharge for up to six weeks after your surgery which will go away. However, call your provider if the discharge has a bad odor, which could suggest an infection, and your provider can give you antibiotics.
Your discharge may also contain blood that looks brown. This is also normal and should eventually go away.
Finally, let your provider know if you have pain or unusual bleeding. Hematomas, a type of painful blood clot, can develop after colpocleisis, but your surgeon can drain them, treat them with antibiotics or remove them.
As you recover, follow your provider’s directions. You may need to:
- Eat a high-fiber diet, and drink plenty of water to prevent constipation after surgery.
- Watch out for signs of a bladder infection, which can develop after surgery.
- Wear compression stockings to prevent blood clots in your legs.
Full recovery can take up to six weeks.
Understanding the outcomes
Colpocleisis is a very successful surgery for treating pelvic organ prolapse, with success rates ranging from 90% to 95%. Many women experience significant relief from discomfort and other symptoms.
In some cases, women can develop bladder and bowel issues after colpocleisis, so go to all your follow-up visits and mention any new symptoms to your provider. They can help you address any new concerns so you can enjoy a high quality of life.