OBJECTIVE: To determine if sacrospinous ligament fixation predisposes to dyspareunia or if vaginal narrowing secondary to repair of associated defects is causative. STUDY DESIGN: We interviewed and examined 36 heterosexual patients preoperatively and at follow-up 15-79 months postoperatively. We inquired specifically as to sexual activity or inactivity and whether sexual function had improved or declined since surgery. RESULTS: Postoperatively, sexually active patients re ported either an improvement or no change in sexual function unless vaginal narrowing occurred. Vaginal narrowing caused apareunia in three postoperative patients. Death of the partner was the most common reason for sexual inactivity preoperatively or postoperatively. CONCLUSION: Sacrospinous ligament fixation did not predispose to dyspareunia unless vaginal narrowing due to repair of associated defects was present.