Objective — to reduce the rate of severe and recurrent genital prolapse in elderly and senile patients, by optimizing the treatment of these patients. Subject and methods. One hundred and seventy patients aged 55 to 78 years with severe genital prolapse were examined and operated on. Group 1 comprised 96 patients with severe descent and prolapse of the vaginal walls. Group 2 included 74 patients with complete or incomplete uterine prolapse (cervical stump) concurrent with grade III cystorectocele; among whom 46 patients (Subgroup 2A) led sexual life and 28 (Subgroup 2B) did not. All the patients of Group 1 and Subgroup 2A underwent extraperitoneal colpopexy using a polypropylene implant. Those in Subgroup 2B had midline colporrhaphy (Neugebauer—Le Fort operation). Results. The surgical treatment performed was noted to be highly effective and to be responsible for the low incidence of intra- and postoperative complications. There were a small number of contralateral vaginal wall descent progression cases corrected with resurgery. Conclusion. Vaginal extracorporeal colpopexy using polypropylene implants, which results in minimal eliminable complications and recurrences, is the most effective operation to treat severe and recurrent genital prolapse in elderly and senile women. The unfairly forgotten Neugebauer—Le Fort operation (midline colporrhaphy) is particularly reliable; however, it is applicable to a small cohort of patients who do not lead sexual life. The authors declare no conflicts of interest.