In 1877, Leon Le Forts reported a procedure in which the anterior and posterior walls of the vagina were sutured with apertures on both sides, which has become the classic semi-closure of the vagina, also known as the LeFort procedure. In 1925, the LeFort procedure was followed by the total vaginal closure after hysterectomy. Traditionally, vaginal closure is considered to be indicated in advanced age (>75 years), in those who cannot tolerate vaginal reconstruction, and as a remedy for failed previous surgery. Because of the high success rate after vaginal closure (90-100%), the low complication rate (about 2% for serious complications; about 15% for general complications) and the rapid postoperative recovery. Due to the aging of the population, the percentage of older women over 75 years of age is increasing. As a result, the proportion of vaginal closure procedures has increased and there is a tendency to broaden its indications. It is believed that vaginal closure can be considered in patients older than 75 years with severe pelvic organ prolapse, combined with multiple medical diseases and no sexual requirements. In contrast, vaginal closure is contraindicated in patients who are not menopausal, who have sexual requirements, who have malignant or precancerous lesions of the reproductive system, or who have severe cardiac, cerebral, or pulmonary dysfunction. However, there are still controversies regarding the age, type and degree of prolapse, and sexual function of patients for whom vaginal closure is indicated. According to official statistics from the US Census Bureau, the number of women aged 85 years or older will increase by a factor of 1 by 2050, and the number of women aged 65 years or older will reach 90,000,000. as the population ages, the proportion of vaginal closure procedures will increase further. The average age is generally considered to be around 75 years. However, the literature reports postoperative regret in about 0-12.9% of patients after vaginal closure and is not related to patient age. Because of the high risk of perioperative cardiovascular and cerebrovascular accidents and thromboembolism in elderly patients, the patient’s cardiac, cerebral and pulmonary function should be fully evaluated before surgery. Local or regional anesthesia is the best choice for vaginal closure. To reduce the risk of thromboembolism, a continuous pressure pump for the lower extremities is applied intraoperatively and postoperatively, early postoperative bed mobility, and prophylactic medication with low-molecular heparin 24 hours postoperatively for those at high risk of thrombosis. Postoperative complications occur in approximately 5% of cases and include cardiovascular events, cerebrovascular accidents, lower extremity venous thrombosis, and pulmonary embolism. Other less severe comorbidities occur at a rate of approximately 15%, such as postoperative morbidity, pneumonia, persistent vaginal bleeding, hydronephrosis, hematoma, ureteral obstruction, and urinary tract infection. The operative mortality rate is 1/400. the complication rate is low compared to pelvic floor reconstructive surgery due to the shorter and less invasive operation time. Therefore, the average age of vaginal closure can also be appropriately lowered for patients who are frail, combined with various medical diseases, declining self-image perception, no sexual life requirement, and have contraindications to pelvic floor reconstruction surgery; on the contrary, the age boundary can be appropriately raised for patients who are in good physical condition, have high self-image perception and good tolerance to surgery. 2. Type and degree of prolapse The factors to be considered in the selection of the surgical method include: whether the patient tolerates the surgery, postoperative recovery time, intraoperative and postoperative complications, the risk of surgical auxiliary materials, and the requirements for sexual life. In addition to the success rate of Xu’s surgery, doctors should pay more attention to the patient’s expectations and quality of life requirements. At present, the evaluation of the efficacy of pelvic floor reconstruction surgery has shifted from the original focus on the degree of improvement of the patient’s objective indicators to more focus on the patient’s satisfaction with the expectations and goals of the surgery, which has a guiding meaning for the physician’s choice of surgical modality. Vaginal closure is the best option for mid-pelvic defects, with a POP-Q score of stage III-IV uterine prolapse, but can also be used in patients with anterior, mid and posterior pelvic defects, with anterior vaginal wall prolapse or posterior vaginal wall prolapse predominantly. Vaginal closure is also indicated in elderly patients with POP who have a POP-Q score of stage II but have a short vaginal length (<5>8 cm), symptoms of prolapse, or failed vaginal reconstruction surgery. A survey on the health and sexuality of the elderly showed that the percentage of women aged 57-64, 65-74 and 75-85 who were sexually active were 62%, 40% and 17%, respectively. This sexual activity refers to consensual activities, including sexual contact, intercourse and orgasm. The literature reports a low incidence of postoperative regret in patients followed up for vaginal closure, about 0-12.9%, and even though patients felt regret after surgery, half of them still expressed willingness to undergo such procedures. Therefore, patients with severe pelvic organ prolapse who are advanced in age, ≥75 years, and without sexual requirements are considered indications for vaginal closure. However, disagreement is also held. According to Huang et al. about 30% of women aged ≥65 years have moderate sexual requirements. Another retrospective data showed the choice of surgical procedure in 116 patients aged ≥75 years with pelvic organ prolapse, including 102 cases (73.9%) for femoral hysterectomy + McCall posterior fornixoplasty, including 106 cases (76.8%) for anterior vaginal wall repair, 36 cases (26%) for posterior vaginal wall repair, and 4 cases (2.9%) for vaginal iliocostalis suspension, while Only 9 cases (6.5%) were selected for vaginal closure. The objective success rate of surgery was 87.6% subjective success rate 86.4%, intraoperative complications 0.7% and postoperative complications 3.6%. The authors concluded that although pelvic floor reconstruction surgery is relatively more technically demanding than vaginal closure surgery, and the operative time is longer than vaginal closure surgery, it does not affect the safety of surgical treatment. This shows that it is very important to give full informed consent to the patient and spouse before vaginal closure and to fully inform about the postoperative changes in vaginal anatomy. This procedure is only indicated for patients who do not require sexual intercourse. In conclusion, vaginal closure is an effective and safe surgical treatment option for elderly, frail patients with severe pelvic organ prolapse who do not require sexual intercourse. However, its effect on quality of life and the patient’s postoperative psychological status still needs further evaluation.