PIP: To evaluate vaginal hysterectomy as a method of surgical sterilization, the experiences of 100 20-39 year old patients, with an average parity of 5.5, undergoing this procedure at the University of Kentucky Medical Center were compared with an equal number of patients matched for age and gravidity undergoing puerperal tubal ligation. Vaginal hysterectomy was performed by the Heaney technique with an average blood loss of 303 ml. The most frequent complication was fever, occurring in 22% of the patients, caused most commonly by vaginal cuff cellulitis and urinary tract infection. The average hospital stay for this procedure was 6 days. In the 100 cases of tubal ligation, the total morbidity rate was 9.0%, caused most often by pelvic infection and pneumonia, and the average hospital stay lasted 4.5 days. The mean estimated blood loss ranged from 44.1 to 53.0 ml. Despite the greater number of operative complications associated with the vaginal hysterectomy, the procedure has 2 distinct advantages over tubal ligation: 1) absolute sterilization effectiveness, and 2) prevention of future uterine disease. It is concluded that vaginal hysterectomy is an acceptably safe and highly effective sterilization procedure, and is particularly suited to the indigent multiparous patient who is most susceptible to future uterine disease and who will probably not return for adequate follow-up.