A vaginal manipulator includes a head with a tissue index, a door, and a head extender that are attached to the head. The head has an anterior side opposite a posterior side. The tissue index has a first arm that is slidingly engaged with a first groove formed in a first lateral edge of the head, a second arm that is slidingly engaged with a second groove formed in a second lateral edge of the head, and a rib connected between the first and second arms and disposed laterally across the anterior side of the head. The door is coupled to and movable relative to the posterior side of the head. The head extender is removably attached to a distal end of the head.