A patient is presented with pelvic descensus after abdominoperineal resection of the rectum and later excision of a vaginoperineal fistula. To provide a satisfactory repair it was necessary not only to reconstruct the anterior vaginal wall but also to provide adequate posterior support without which the cystocele and residual urine, which had been present, would probably have reformed. The pelvic floor, perineum and posterior vaginal wall were reconstructed by using fascia lata strips on the anterior vaginal wall and by advancing to the midline the soft tissue remaining adjacent to the defect. Such repair can be successful if adequate tissue remains and if enough mobility can be obtained to leave little tension on suture lines. Anatomic and functional results in our patient were excellent. The etiology and management of vaginal reconstruction is discussed.