At 16 years old, Xiaoqing is the legendary “stone girl” with no vagina or uterus. In general, congenital absence of a vagina can be one of two things: first, there is no uterus or only a primordial uterus (i.e., no functional uterus); second, the uterus and ovaries are normally developed. If there is no uterus, vaginoplasty can be performed six months before marriage; if there is a uterus, the procedure should be performed at puberty, otherwise it can cause pelvic pain and abdominal pain due to menstrual reflux. After vaginoplasty, patients in both cases can have a normal sexual life. However, when it comes to fertility, at present, the former is no longer possible and the latter is still possible. How are stoned girls found? Most patients are discovered after puberty, when they have no menstruation, or when they have periodic lower abdominal pain. congenital anovagina can be detected earlier. The main treatment for congenital anovagina is vaginoplasty. The principle of this procedure is to separate an artificial cavity about 8 to 10 cm long between the bladder and rectum, cover the cavity wall with tissue made of various materials and fill it with gauze so that the tissue grows close to the cavity wall to form an artificial vagina. After about 7 to 10 days, when the tissue covering the wall of the cavity has grown well, it can be replaced with a rigid model to prevent collapse of the artificial vagina, tissue contracture and adhesions. After six months, the patient will be able to have a normal sexual life. Since uterine transplantation and artificial wombs are still not possible, it is not yet possible for congenital anovaginal patients without a uterus to have normal fertility; even if they have a uterus, it is technically difficult to connect the artificial vagina to the uterus, so it is also difficult for congenital anovaginal patients in this category to achieve their fertility wishes. How is vaginoplasty performed? There are different types of vaginoplasty, mainly because the material used to cover the vaginal wall varies. Some of the more common ones are: sigmoid colon, peritoneum, amniotic membrane and biological patches. Among them, sigmoid colon and peritoneum are the most used. 1. Sigmoid colon method: effective but traumatic Sigmoid vaginoplasty requires the assistance of a surgeon to open a section of the sigmoid colon that maintains blood flow and transplant it into the formed vaginal cavity. Since the intestine is directly used instead of the vagina, there is no need for the epithelial crawling growth of the vaginal mucosa, and the vagina usually does not contract or adhere after the operation, and the intestinal mucosa is more secreted, which makes sex better. However, this operation requires cutting a section of intestine, which is more traumatic to the patient, and the artificial vagina made of colon has an odor, which may cause inconvenience to the patient’s life. 2. Peritoneal method: small incision without involving organs The peritoneal method of vaginoplasty is to peel off part of the pelvic peritoneum and pull down the peritoneum to line the wall of the artificial vagina. However, due to the relatively low secretion of peritoneum, the effect of sex life is not as good as the artificial vagina made by sigmoid colon, but normal sex life can be guaranteed in general. 3. Amniotic membrane method: simple but much secretion The amniotic membrane method of vaginoplasty mainly uses fresh amniotic membrane as biological dressing, which covers a high growth rate and can play a role in preventing trauma infection and fiber scaffolding. The final vagina formed is usually similar to the natural vagina after 3 to 6 months. This procedure is the easiest and safest to perform, but should be performed with strict aseptic technique, otherwise it is prone to failure due to infection. The advantages of amniotic vaginoplasty are low cost, short operation and anesthesia time, but much discharge after the operation. 4. Biopatch method: good results but too expensive Biopatch vaginoplasty involves covering the four walls of the artificial vagina with a biopatch. This biological patch is a natural extracellular matrix obtained by decellularization of allogeneic tissue using tissue engineering techniques. This material is characterized by its non-toxicity and its good histocompatibility, which does not provoke an immune rejection of the body. The advantages are the short operation and anesthesia time, the short postoperative mucosalization time and the corresponding shortening of the time needed to wear the mold, and the thicker, smoother and more elastic vaginal mucosa that is formed. However, the cost is too high and the tip of the reconstructed vagina is susceptible to the growth of granulation tissue.