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1Department of Obstetrics and Gynecology, Istanbul University School of Medicine, Istanbul; 2Department of Obstetrics and Gynecology, Gazi University School of Medicine, Ankara; 3Department of Plastic and Reconstructive Surgery, Istanbul University School of Medicine, Istanbul, Turkey Correspondence: Dr Ercan Bastu, Istanbul University School of Medicine, Department of Obstetrics and Gynecology, Division of Infertility, Capa 34093, Istanbul, Turkey. Telephone 90-532-413-4195, e-mail [email protected] Congenital vaginal agenesis is a rare malformation that has an incidence of one in 4000 to 5000 female newborns (1). Although vaginal agenesis is most commonly encoutered in women with Rokitansky syndrome (Mayer-Rokitansky-Kuster-Hauser syndrome or Müllerian aplasia) (2) and androgen insensitivity syndrome (AIS), it can also present in patients with Turner syndrome, Morris syndrome and as a part of combined congenital defects. Patients with Rokitansky syndrome and AIS have normal secondary sex characteristics and external genitalia. These patients present with primary amenorrhea typically in adolescence. A blind or absent vagina is discovered during gynecological examination in such patients. The purpose of the treatment is not only to create an adequate passageway for penetration but also to facilitate satisfactory sexual intercourse. There are several nonsurgical and surgical treatment techniques described in the literature for treatment of vaginal agenesis. Nonsurgical options include vaginal dilation with a dilator, while surgical options include the Vecchietti procedure (3-5), Davydov technique (6), McIndoe technique (7) and intestinal vaginoplasty. The first vaginal reconstruction was performed by Amussat in 1832 (8). In 1872, Heppner was the first surgeon who used split thickness skin grafting for vaginoplasty (9). Baldwin used a vascularized segment of ileum to create a new vaginal canal in 1908, while Wagner used sigmoid colon for the same purpose in 1927 (10). The McIndoe technique was first described in 1938 by Bainster and McIndoe (9). Despite the existence of several alternative methods, there is still no consensus regarding the best option for surgical correction The aim of our study was to present the results of a modified McIndoe technique with respect to sexual function, vaginal length and complication rates in patients with vaginal agenesis.