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Urogynaecology · London

Sacrospinous ligament fixation - London.

A vaginal, native-tissue repair for vault or uterine prolapse - done by a subspecialist urogynaecologist in a London unit, with no synthetic mesh, and with sacrocolpopexy and uterosacral pathways in the same MDT if SSLF is not the right call for you.

A stethoscope on a clinical desk

Indicative pricing

What private SSLF costs in London.

All-inclusive packages across UK London units. Consultation, surgery, anaesthetic, hospital stay and follow-up bundled into one figure.

In short

A private SSLF in London: £8,500 to £16,000 all-inclusive, home in 1 to 2 nights.

Procedure Indicative range
Urogynaecology consultation and POP-Q assessment £280–£450
SSLF - vaginal vault prolapse (post-hysterectomy) £8,500–£12,500
SSLF + anterior or posterior colporrhaphy £10,500–£14,500
Sacrohysteropexy variant (uterus preserved) £11,000–£15,500
SSLF + vaginal hysterectomy £12,000–£16,000
Second-opinion review of prior repair or MRI £280–£480

Prices vary by London unit, by the urogynaecologist, and by concurrent procedures. A vaginal hysterectomy adds roughly £2,500 to £4,500.

What SSLF is

A vaginal, native-tissue reconstruction for apical prolapse.

Sacrospinous ligament fixation anchors the vaginal vault or cervix to a strong pelvic ligament using non-absorbable sutures. No mesh, no abdominal incisions, and a decades-long safety record.

  • Native tissue, no mesh

    Non-absorbable sutures anchor the vaginal vault or cervix unilaterally to the right sacrospinous ligament. No synthetic material implanted.

  • Vaginal approach

    The whole operation is done through the vagina - no abdominal or laparoscopic incisions, no umbilical scar, faster wake-up and lower deep-vein thrombosis risk.

  • Fixes apical (top) prolapse

    Restores the top of the vagina or the cervix to a physiological position. Often combined with an anterior or posterior repair to fix any concurrent bulge.

Who benefits

When SSLF is the right operation - and when it is not.

  • Post-hysterectomy vault prolapse

    The commonest indication. The vaginal vault descends after a prior hysterectomy - SSLF re-suspends it to the sacrospinous ligament without mesh.

  • Uterine prolapse without hysterectomy

    Sacrohysteropexy variant preserves the uterus for women who want fertility, avoid hysterectomy, or need faster surgery.

  • Patients wanting a no-mesh option

    Native-tissue reconstruction using the woman’s own ligaments and non-absorbable sutures - no synthetic mesh implanted.

  • Unfit for abdominal or laparoscopic surgery

    Frail or high-cardiac-risk patients tolerate a vaginal approach under regional anaesthetic far better than a long laparoscopic sacrocolpopexy.

  • Recurrent apical prolapse after prior repair

    Failed anterior repair or previous colpopexy with recurrent vault descent - SSLF is a reasonable second-line reconstructive option.

  • Single-sided repair suits the anatomy

    A right-sided unilateral suspension is often enough. Bilateral SSLF is possible but rarely needed.

  • Older patients wanting durable apical support

    Native-tissue durability of 60 to 75% at 5 years is often perfectly adequate for a patient in her 70s or 80s.

  • Not for: young sexually active with high demands

    A 45-year-old with a physical job and stage IV prolapse is often better served by sacrocolpopexy - we say so.

Approach and combined procedures

SSLF is a family of variants - and rarely done alone.

Vaginal only, GA or spinal, 90 to 120 minutes. Concurrent anterior or posterior colporrhaphy, a vaginal hysterectomy if the uterus is in situ, and (occasionally) a mid-urethral sling if there is stress urinary incontinence - though sling timing is now debated.

  • Unilateral right SSLF

    The standard. One or two non-absorbable sutures placed through the right sacrospinous ligament, 2 fingerbreadths medial to the ischial spine, avoiding the pudendal neurovascular bundle.

  • Bilateral SSLF

    Both ligaments used - reserved for large defects. Slightly longer procedure, marginal benefit in most cases, avoided if pelvic width is narrow.

  • Sacrohysteropexy variant

    Uterus preserved and the cervix (rather than the vault) sutured to the sacrospinous ligament. Useful for uterine prolapse without hysterectomy.

  • Miya hook technique

    A curved retractor that hooks the ligament from below. Older, tactile approach still favoured by experienced surgeons.

  • Capio suture-passer

    Disposable device that fires and catches the suture in one action - reduces operative time and the learning curve. Now the workhorse in most UK units.

  • Concurrent anterior colporrhaphy

    The anterior wall is often weak too - a native-tissue anterior repair adds 20 to 30 minutes and reduces the risk of anterior recurrence.

  • Concurrent posterior colporrhaphy

    For rectocoele or posterior wall descent. Done through the same posterior vaginal incision, no extra scar.

  • Sacrocolpopexy (when SSLF is not enough)

    Laparoscopic or robotic abdominal approach with lightweight polypropylene mesh - the durability benchmark. Longer surgery, higher recovery cost, mesh trade-off.

Outcomes and comparisons

SSLF vs sacrocolpopexy vs uterosacral suspension.

Apical support at 5 years is 60 to 75% with SSLF versus 90 to 95% with sacrocolpopexy. Anterior recurrence sits around 20 to 30% - which is why we frequently combine SSLF with an anterior repair. Buttock pain in 5 to 10% is usually transient.

  • SSLF

    Vaginal, no mesh, 90 to 120 min, 1 to 2 nights, 2 to 3 weeks to desk work. 60 to 75% apical durability at 5 years. Buttock pain 5 to 10%.

  • Sacrocolpopexy

    Laparoscopic or robotic, polypropylene mesh, 150 to 240 min, 1 to 2 nights, 4 to 6 weeks off. 90 to 95% durability at 5 years. Mesh trade-off.

  • Uterosacral suspension

    Vaginal, no mesh, bilateral high suspension using uterosacral ligaments. Similar durability to SSLF, marginal differences unclear in head-to-head trials.

Recovery and safety

What to expect afterwards - honestly.

One to two nights in hospital, catheter for 24 to 48 hours, no heavy lifting for 6 weeks, driving and desk work at 2 to 3 weeks, sexual activity at 6 weeks. Buttock pain and voiding difficulty are the two things worth planning for.

  • GA or spinal anaesthetic

    Most SSLF is done under GA. Spinal with sedation is offered to higher-risk patients and gives excellent post-op analgesia for the first 12 hours.

  • Buttock pain - 5 to 10%

    Referred right-buttock pain from suture traction on the pudendal nerve. Usually settles in 2 to 6 weeks. Persistent pain is uncommon and may need suture release.

  • Bladder dysfunction and retention

    A catheter for 24 to 48 hours is routine. 5 to 10% of patients need a longer trial without catheter. New-onset stress incontinence occurs in around 15%.

  • Bleeding and haematoma

    The pudendal vessels sit close to the ligament. Significant bleeding occurs in 1 to 2% of cases - almost always controlled at the time of surgery.

  • Rectal or bladder injury

    Rare - under 1% each. Recognised at the time and repaired primarily. Almost never needs a stoma or further surgery.

  • Dyspareunia (painful sex)

    New-onset painful sex in 5 to 15% - usually related to vaginal narrowing after concurrent posterior repair, less commonly from suture pain.

  • No heavy lifting for 6 weeks

    The critical window for suture-anchored healing. Desk work at 2 to 3 weeks, driving at 2 to 3 weeks, sexual activity at 6 weeks.

  • Vaginal oestrogen cream long-term

    Started before surgery and continued long-term for post-menopausal patients - improves tissue quality and reduces recurrence.

  • Red flags after discharge

    Heavy vaginal bleeding, fever over 38, severe pelvic or buttock pain, inability to pass urine, or offensive discharge - call the unit or attend A&E the same day.

Reading your operation note

Your SSLF note in four parts. Read the last one first.

Whichever variant was used, the operation note keeps to the same shape.

A London urogynaecologist reviewing an SSLF operation note

A quiet reminder

Urogynae language is precise and can read coldly - ask your care team to explain anything that is unclear.

Ask your care team to explain anything that is unclear.

  1. 01 Header

    Prolapse stage and previous surgery

    POP-Q findings before surgery, which compartments were affected, and whether you had a prior hysterectomy or repair.

  2. 02 Technique

    Which side, how many sutures, what device

    Right or left (usually right), Miya hook or Capio, number and type of sutures, and any concurrent anterior or posterior repair.

  3. 03 Findings

    Blood loss, complications, catheter plan

    Intra-operative blood loss, any injuries recognised and repaired, and the plan for catheter removal (usually 24 to 48 hours).

  4. 04 Impression

    Recovery plan and follow-up dates

    Read this first: activity restrictions, vaginal oestrogen plan, 2-week wound check, and 6-week and 6-month POP-Q reassessment dates.

Recognised by major UK insurers

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

Cover for SSLF varies by insurer and by indication - usually funded when symptomatic prolapse is documented.

Frequently asked

Everything we get asked about SSLF.

Quick answers on mesh, recurrence, insurance, uterus preservation, sex after surgery and buttock pain.

  • Is sacrospinous ligament fixation a mesh-free operation?

    Yes. SSLF is a native-tissue reconstructive procedure. The vaginal vault or cervix is anchored to the sacrospinous ligament using non-absorbable sutures - typically Prolene or Ethibond - and often a delayed absorbable stay suture. No synthetic mesh is implanted. That is the main reason many patients and surgeons choose it over sacrocolpopexy after the mesh controversies of the last decade.

  • What is the recurrence rate after SSLF?

    Apical (vault) support is maintained in 60 to 75% of patients at 5 years, compared with 90 to 95% for laparoscopic or robotic sacrocolpopexy with lightweight mesh. The anterior compartment is the commonest site of recurrence at 20 to 30% - which is why we frequently offer concurrent anterior colporrhaphy. Reoperation for recurrent prolapse over 10 years sits around 10 to 15%.

  • Will my insurance cover SSLF?

    Most major UK insurers (Bupa, AXA, Vitality, Aviva, WPA) fund SSLF when symptomatic prolapse is documented on POP-Q assessment and conservative measures (pessary, physiotherapy) have been tried or are unsuitable. Self-pay is straightforward, with all-in packages of £8,500 to £16,000 depending on concurrent procedures.

  • Can I keep my uterus?

    Yes - the sacrohysteropexy variant anchors the cervix rather than the vaginal vault to the sacrospinous ligament, leaving the uterus in place. It is a good option for women who want to preserve fertility, avoid a hysterectomy for cultural or personal reasons, or reduce operative time. Recurrence rates are similar to standard SSLF when done by an experienced urogynaecologist.

  • When can I have sex again?

    Six weeks after surgery, once the vaginal wound has fully healed. Around 5 to 15% of patients report some new dyspareunia in the first few months - usually from concurrent posterior repair narrowing the vaginal calibre rather than from the SSLF itself. Vaginal oestrogen cream and dilator work resolve most cases. Persistent painful sex from suture traction is uncommon and treatable.

  • What causes the buttock pain and does it go away?

    Referred pain to the right buttock affects 5 to 10% of patients. It comes from suture traction on the sacrospinous ligament and the nearby pudendal nerve fibres. In most patients it settles within 2 to 6 weeks with simple analgesia and reassurance. Severe, persistent pain beyond 6 weeks is rare but sometimes requires diagnostic pudendal block and, occasionally, release of the offending suture under anaesthetic.

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