Removal of the fallopian tubes and ovaries at the time of vaginal hysterectomy is a skill that must be acquired if one is to be a competent vaginal surgeon. Various techniques have been described and will be reviewed in this chapter. A single technique or series of steps often must be modified depending on the descent of the adnexa, size and shape of the pelvis, and intraperitoneal pathology. The pelvic surgeon must adhere to the basic surgical principles and understand the anatomic relationships of the adnexa to other pelvic viscera, including the lower urinary tract. Preoperative discussion with all patients regardless of age is imperative in determining their desires for oophorectomy at the time of vaginal hysterectomy.