Context - Second recurrence of vaginal vault prolapse (VVP) is defined as prolapse of the vaginal vault or upper vagina after two previous reconstructive surgeries. The transvaginal bilateral sacrospinous fixation (TBSF) is one of the surgical procedures used for the treatment of VVP. To the best of our knowledge, there are no studies that determined the best surgical technique for the treatment of second recurrence of VVP and therefore guide standard management Objective - We aimed to study the efficacy of TBSF and its impact on quality of life (QoL) and sexual functions in women affected by second recurrences of VVP. Methods - We performed a prospective observational study on 20 sexually active patients affected by second recurrence of VVP, previously treated with monolateral sacrospinosus fixation. Patients - Sexually active, non-smoker, menopausal and symptomatic (sensation of heaviness or pulling in the pelvis, tissue protruding from the vagina, discomfort during sex, urine leakage in case of cough, sneeze or exercise, urine retention) patients affected by recurrent vaginal vault prolapse after vaginal hysterectomy and subsequent previous transvaginal monolateral sacrospinous fixation, stage II or higher according to the POP-Q system. Interventions - TBSF was performed in all the patients. They were evaluated before the surgery and at 12 months follow-up through pelvic organs prolapse quantification (POP-Q) system, Short Form-36 (SF-36) and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). Main outcome measures - The impact of TBSF on quality of life and sexual function. Results - At 12 months follow-up, 18 of 20 (90%) patients had been cured of their recurrent VVP. No major intra- and post-operative complications occurred. We found a significant improvement in 4/5 POP-Q landmarks (excluding total vaginal length), SF-36 and PISQ-12 scores. Conclusions - According to our data analysis, TBSF appears to be safe, effective and able to improve both QoL and sexual functions in patients affected by second recurrence of VVP after previuos monolateral sacrospinosus fixation.