# Colpocleisis (Le Fort Operation)

> Colpocleisis and the Le Fort operation for frail elderly women with complete prolapse, covering counselling, contraindications and screening for NEET-PG OBG.

- Canonical URL: https://prepelephant.com/topics/neet-pg/obstetrics-and-gynaecology/colpocleisis-lefort-operation
- Exam / course: NEET-PG · Subject: Obstetrics and Gynaecology
- Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team
- First published: 2026-10-08
- Last updated: 2026-10-08
- Reference basis: Shaw's Textbook of Gynaecology; Dutta's Textbook of Gynecology; Williams Gynecology
- How to cite: "Colpocleisis (Le Fort Operation)", PrepElephant, https://prepelephant.com/topics/neet-pg/obstetrics-and-gynaecology/colpocleisis-lefort-operation

## Direct answer

Colpocleisis is an obliterative operation that closes the vaginal canal to correct complete uterovaginal prolapse, and the Le Fort variant leaves a small channel near the introitus so the uterine cavity can drain. It suits frail elderly women who are no longer sexually active and cannot tolerate a long reconstructive operation, with high satisfaction and low recurrence in selected series. Because the operation is effectively permanent, the woman must accept that intercourse and vaginal delivery become impossible, and endometrial and cervical screening must be complete beforehand.

## What you must remember

- **Le Fort partial colpocleisis:** the anterior and posterior vaginal walls are sutured together, leaving a small drainage channel near the introitus, with the uterus usually retained.
- **Total colpocleisis:** complete closure of the vagina, usually performed after hysterectomy or when the uterus is absent, because no drainage channel is left for a retained uterus.
- **Indication:** complete procidentia in a frail elderly woman with no sexual activity and significant comorbidity that precludes a long anaesthetic.
- **Contraindications:** sexually active women, women wanting future vaginal delivery, and anyone with undiagnosed uterine or cervical pathology, including endometrial carcinoma.
- **Pre-operative screening:** cervical cytology and endometrial assessment, since the uterus or cervix may remain in situ after the operation.
- **Complications:** pyometra or haematometra when drainage is inadequate, urinary retention, cystitis and recurrent cystocoele.
- **Consent:** the operation is irreversible, so counselling must cover loss of intercourse and the continued need for cervical screening.

## Counselling an 81-year-old with complete prolapse

An 81-year-old widow with heart failure and mild dementia presents with complete procidentia, with ulceration at the cervix and difficulty walking to the toilet. She has not had sexual intercourse for over 20 years, and her family wants a definitive, low-risk option.

1. **Exclude malignancy.** Confirm that the prolapse is uterovaginal and that no malignancy is present, using cervical cytology and endometrial assessment with sampling of the endometrium where indicated.
2. **Assess fitness.** Her cardiac status and anaesthetic risk make a reconstructive operation with a long anaesthetic unattractive.
3. **Counsel the family.** The operation closes the vagina permanently, she cannot have intercourse afterwards, and the cervix or uterus may remain in place, so pyometra and cervical screening remain relevant.
4. **Choose the variant.** The Le Fort variant keeps a small drainage channel, while total closure removes that channel and is chosen only when drainage is not needed.
5. **Document consent.** The surgeon records the consent conversation, including the irreversible nature of the decision.

If she were sexually active or wanted a future vaginal delivery, the same prolapse would be treated with a reconstructive operation instead.

## Where the examiner checks the contraindication list

Viva questions on colpocleisis usually turn on contraindications and screening.

- **Trap:** forgetting the pre-operative screen. — **Correct:** a closed vagina can hide undiagnosed endometrial carcinoma, so name endometrial assessment before any obliterative surgery.
- **Trap:** offering colpocleisis to a woman who wants to keep sexual function. — **Correct:** it is inappropriate there, and a reconstructive operation or pessary is offered instead.
- **Trap:** confusing Le Fort partial colpocleisis with total closure. — **Correct:** the partial operation keeps a channel for uterine drainage, while total closure does not.

## Frequently asked questions

### Which women are suitable for colpocleisis?

Colpocleisis suits frail elderly women with complete prolapse who are no longer sexually active and cannot tolerate a long reconstructive operation. The woman must understand that the operation is permanent and that intercourse becomes impossible afterwards.

### Why must endometrial carcinoma be excluded before colpocleisis?

Endometrial carcinoma must be excluded before colpocleisis because the closed vagina obscures the cervix and uterus, delaying diagnosis of bleeding or malignancy. Cervical cytology and endometrial assessment are therefore part of the pre-operative screen.

### What does the Le Fort operation leave behind that total colpocleisis does not?

The Le Fort partial colpocleisis leaves a small channel near the introitus so that the uterine cavity can drain, whereas total colpocleisis closes the vagina completely. The channel reduces the risk of pyometra or haematometra in a retained uterus.

### What are the main complications of colpocleisis?

Pyometra or haematometra, urinary retention, cystitis and recurrent cystocoele are the main complications of colpocleisis, with pyometra more likely when drainage is inadequate. Long-term cervical screening is needed if the cervix is retained.