Vaginal tubal sterilization was once the procedure of choice for interval sterilization. This technique fell out of favor in part because of a perceived increase in morbidity over the evolving laparoscopic techniques. Complications should be minimized by the advent of routine antibiotic prophylaxis and improved operating techniques that allow shorter procedure times. We retrospectively reviewed 240 vaginal tubal sterilization procedures performed by a single physician. Long-term follow-up (more than 5 years) was available in over half the study group (52%). Half of all operations were completed in 12 minutes or less, with an average time of 14.5 minutes. The planned vaginal procedure was completed in all but two cases, both of which required laparotomy secondary to dense adhesions. Median estimated blood loss was 20 mL. No postoperative infection was encountered. These data suggest that vaginal tubal sterilization may still be a safe alternative for interval sterilization.