Purpose of Review <p>This review explores the role of genital hiatus (GH) size in predicting long-term outcomes following apical prolapse repair, including anatomical recurrence, symptom burden, quality of life, and patient satisfaction.</p> Recent Findings <p>Recent studies show that larger postoperative GH measurements are associated with an increased risk of anatomic and surgical failure, across various surgical technique. A smaller post-operative GH size is consistently linked with long-term success, while GH size measured pre- and intraoperatively is less predictive of long-term outcomes. Some studies show that GH modification such as perineorrhaphy reduces GH size and improves quality of life without compromising sexual function. However, there is significant variability in surgical practice, and the utility of concomitant GH reduction is debated.</p> Summary <p>Postoperative GH size is a consistent and modifiable predictor of surgical outcomes in apical prolapse repair. Further research is needed to standardize GH measurement threshold and timing, as well as to assess whether GH modification should be routinely incorporated into prolapse repair surgeries.</p>