A vaginal hysterectomy is the commonest surgical procedure performed for uterine prolapse. The vaginal route has been shown to be the safest and most cost-effective for hysterectomy even in the absence of prolapse. Most women with a uterine prolapse are suitable for a vaginal hysterectomy with a few exceptions. Though usually safe the procedure should be undertaken by those with adequate training and expertise in pelvic floor surgery. When offering women a vaginal hysterectomy for pelvic organ prolapse the non-surgical as well as the surgical alternatives should be discussed and where facilities for performing these are not available the patient should be given the option of referral to another unit able to offer these.