Congenital absence of the vagina is a congenital abnormality of the female genital tract, often referred to as “stone girl”, with a prevalence of about one in a thousand. The incidence is about 1 in 1,000. Many patients with congenital absence of vagina are found to have no menstruation after puberty. Most patients have well-developed breasts at puberty and obvious female secondary sexual characteristics; the reason for the lack of menstruation is that they do not have a uterus, or only have a very small, non-functioning uterus (medically known as the fundic uterus). Patients often come to the hospital and are diagnosed with the disease only after they experience primary amenorrhea after puberty, or have difficulty having sexual intercourse after marriage. If left untreated, it certainly affects the patient’s quality of life. Patients with congenital anovulation without a uterus or with only an initiating uterus do not have the possibility of pregnancy (ovulation can be normal). However, it is possible to reconstruct the vagina through medical means to achieve the goal of being able to have sex. The best time to have the surgery is when you have a boyfriend and are ready to get married. The main treatment for congenital absence of a vagina is surgery, known as “artificial vaginoplasty”, except in some cases where a vagina can be “pushed” out using a non-surgical procedure called pectus excavatum (a non-surgical procedure). In this procedure, a cavity about 8 to 10 centimeters long is isolated between the bladder and the rectum, and various tissues are used to cover the four walls of the cavity, which are then filled with gauze so that the tissues grow tightly against the walls. After about 7 to 10 days, the covered tissue grows well. At this point it can be replaced with a rigid model to ensure that the artificial vagina made does not collapse and to prevent tissue contracture. At present, there are more than 20 types of vaginoplasty, which are named differently because of the different padding used for artificial cavity creation. The commonly used ones are: amniotic membrane method of vaginoplasty, peritoneal method of vaginoplasty, sigmoid colon vaginoplasty, skin flap vaginoplasty, and biopatch method of artificial vaginoplasty, etc. Each method has been used in clinical practice for a long time, and is often used to make a vagina. Each method has been used in the clinic for a different period of time and has different advantages and disadvantages. The main surgical treatments and their advantages and disadvantages are introduced as follows: I. Bio-patch method of artificial vaginoplasty: At present, doctors at home and abroad use medical tissue patches to cover the four walls of the artificial vagina, so as to achieve the purpose of reconstructing the vagina. The so-called “biological patch” is the use of tissue engineering technology, the allogeneic tissue through the decellularization process, a natural extracellular matrix, is a dermal substitute. The most significant features of this new material are: non-toxic, good histocompatibility, will not trigger the body’s immune rejection. Clinical applications have shown that the procedure is relatively simple, requiring only about 30 minutes of intravenous anesthesia (as opposed to “general anesthesia”), with minimal complications and bleeding. By 4 to 12 weeks after the procedure, most of the patient’s vagina is mucosalized – meaning that the “made” artificial vagina has been successful. Compared to other methods of forming an artificial vagina, the advantages of the biopatch method are shorter surgery and anesthesia time, shorter mucosalization time after surgery, shorter time needed to wear the mold, and the formed vaginal mucosa is thicker, smooth and red, with good elasticity, and the formation of scars and contractures are not obvious, which greatly improves the quality of the patient’s daily life. However, the disadvantage is the high cost, in addition to the reconstructed vagina is easy to grow granulation tissue at the top. Second, peritoneal vaginoplasty: With the development of minimally invasive technology, laparoscopic technology is becoming more and more perfect, and the peritoneal vaginoplasty completed through laparoscopic route has also been widely carried out. The so-called “peritoneal vaginoplasty” is a procedure in which the peritoneum of the pelvic wall is separated, pulled downward, and lined in the cavity separated from the vagina to artificially form a vagina. After years of practice, our laparoscopic peritoneal vaginoplasty takes about 40 minutes to perform, fully embodies the concept of minimally invasive, and the post-operative vaginal depth and sexual satisfaction are significantly higher than the traditional amniotic membrane method. Another advantage of this method is that the tip of the reconstructed vagina is smooth and not easy to grow granulation tissue, which eliminates the trouble of dealing with granulation tissue on an outpatient basis. Third, the amniotic membrane method vaginoplasty: this surgical method uses fresh amniotic membrane, as a temporary biological dressing, covering the high growth rate of amniotic membrane, can play a role in preventing trauma infection and fibrous scaffolding. After the procedure, the mucosal epithelium of the vaginal vestibule grows into the cavity along with the scaffolding and slowly “crawls” throughout the vagina. After 3 to 6 months, the resulting vagina is very similar to a natural vagina. This procedure is the easiest and safest to perform, but should be performed with strict aseptic technique, as it is prone to failure due to infection. The advantages of amniotic vaginoplasty are low cost, short operation and anesthesia time, the disadvantage is that there is a lot of discharge after the operation. Fourth, the sigmoid colon vaginoplasty: this surgical method needs to open the abdomen (different from “minimally invasive”), free a section of the sigmoid colon to maintain blood flow, and this section of the sigmoid colon transplanted into the vaginal cavity of the molding. Since this surgery directly adopts the intestines to substitute for the vagina, without the need for the vaginal mucosal epithelium to “crawl” and grow, the vagina does not contracture after the surgery, and can remain wide and smooth, and can be free of the vaginal model. However, the operation method is complicated and traumatic to the patients, and the secretion of intestinal fluid is more in the short term after the operation, and there will be odor in the vagina, which will bring inconvenience to the patients’ life. Fifth, their own skin flap vaginoplasty: this procedure is to obtain the patient’s own skin for free skin, transplanted into the vaginal cavity molded. Commonly used to take the skin piece of the vulva, double groin, abdomen, etc., the skin piece of the survival rate is high, the success rate of the operation is also very high. However, after the removal of the skin flakes, the scars left in the skin donor area will be more obvious, there is hair growth after abdominal dermatoplasty, and the formed skin vagina will be more dry due to the lack of secretion function, resulting in a less than satisfactory sex life after the operation. These are the common surgical methods used to treat congenital absence of vagina. It is worth noting that the best time for patients to undergo surgery is when they are ready to get married, or are already married; otherwise, they will need to wear the mold for a long time after the surgery, which will bring a lot of inconvenience to their life.