Sacrospinous ligament fixation of the vagina was performed on 48 of 135 patients at the time of transvaginal hysterectomy. All 48 patients in the group had at least moderate or severe uterovaginal prolapse and symptomatic pelvic relaxation, which is described herein. In five patients cystoceles developed, in two patients rectoceles developed, and one patient has had vault prolapse subsequent to surgery. Morbidity was minimal. Postoperative results indicate that sacrospinous ligament fixation of the vagina can be a useful adjunctive procedure when performed at the time of vaginal hysterectomy.