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With the aging of our population, vaginal vault prolapse is being seen with increased frequency. Successful treatment of vaginal prolapse due to weakened support of the vaginal vault is dependent upon accurate identification of a prolapsed vaginal apex and any other coexisting vaginal segment prolapse. Although non-surgical treatment options such as pessaries can be effective, definitive therapy requires surgical intervention1. Both abdominal and vaginal approaches to vaginal vault prolapse are very effective2. The choice of a surgical approach should be based on individual patient factors, such as sexual activity level and associated vaginal support defects. New techniques utilizing adjuncts such as bone anchors and synthetic mesh materials have enhanced the safety and efficacy of reconstructive surgery. In the advanced elderly patient who carries a significant surgical risk, vaginal obliterative procedures can simply and effectively address vaginal vault prolapse in the outpatient setting.