It is everyone’s wish to find someone to love truly and spend their life with them. Because love is the most beautiful music in the world and sex is their common rhythm. Two people reach the union of spirit and flesh, which is the sublimation of life and the need of life. However, not every woman can be lucky to enjoy sex. Due to congenital or acquired factors, some people are unable to have intercourse and enjoy a female sex life due to the absence of vagina, such as congenital absence of vagina, vaginal atresia, hermaphroditism, acquired perineal injury, vaginal agenesis due to pelvic clearance after tumor removal, as well as men who require feminization have vaginal reconstruction requirements. Patients with vaginal defects are difficult to talk about, and after vaginal rejuvenation they do not want their sexual partners to find out that their vagina is fake, so it is crucial to create a vagina that is close to normal and leaves no traces. The ideal vagina should not only resemble a normal vagina in form and appearance, but also in function and sensation, improving the comfort of the artificial vagina. This is the patient’s desire and the goal of the plastic surgeon performing vaginal rejuvenation. So, how can an artificial vagina meet the patient’s needs? 1. Appropriate size The artificial vagina should first be similar to a normal vagina in size and dimensions. In Asian women, the vagina is 6-10 cm deep, 7 cm on average, and can accommodate 2 fingers wide. This is the most basic condition and the first step in the procedure, which is to create a cavity of the right size between the anus and the urethra. The cavity is then covered with a vaginal lining of a different material and when the wound is completely healed, the vaginal reconstruction is almost complete. The nomenclature of the procedure varies depending on the coverings. Commonly used vaginal linings are amniotic membrane, skin flaps, skin flaps, intestinal canal and oral mucosa. 2. Softness and lovemaking The normal vagina is covered by mucous membrane and has a soft, smooth, elastic lining with a stable shape and no contractures. Artificial vagina should also meet this standard. The vaginal mucosa is similar to the oral mucosa and consists of unkeratinized squamous epithelium. The rich capillaries of the vagina become engorged with blood during sexual arousal and produce a thin mucus that flows from the vagina to the vulva, lubricating it and facilitating sexual intercourse. The artificial vagina should have a realistic effect and should not show any signs of scarring or defects in the perineum, unpleasant discharge, vaginal contracture or hair growth, or long-term use of a support that is unacceptable to the patient. There are numerous surgical approaches to vaginal reconstruction, the main ones being amniotic vaginoplasty, cutaneous vaginoplasty, enterovaginoplasty, and buccal mucosal vaginoplasty, each of which has its own advantages and disadvantages. The choice of amniotic membrane as a lining may spread disease, cause rejection, take longer to heal, take longer to use a support, and tend to contract, resulting in a shorter and narrower vagina. Skin vaginoplasty is divided into skin grafts and flap grafts. This method leaves unsightly scarring on the body surface, feels dry, is not smooth and soft, and has the potential for intravaginal hair growth. Although labia minora flap vaginoplasty is less invasive, has fewer complications and is close to a normal vagina, it is only suitable for those with larger labia and causes defects to the anatomical shape of the perineum. Therefore, a vaginal reconstruction with the same or similar tissue material that leaves no marks or defects on the body surface should be the preferred surgical method. So, which methods are effective, sensory and create a more realistic vagina? 1.Small intestine vaginoplasty The choice of intestinal vaginoplasty has basically stabilized after going through from rectum, sigmoid colon, ileocecal to small intestine. Because of the fecal odor of the secretions from vaginal reconstruction with the large intestine, vaginoplasty of the small intestine is quite popular, especially ileocecal vaginoplasty is the most popular. The ileum is richer in blood flow than the large intestine, the intestinal cavity is cleaner, the infection rate is low, the mobility is high, and the tension is low, which ensures a good blood supply to the intestinal wall, and the vagina has a high survival rate, is smooth, soft, and elastic, and the secretion function is close to normal, which can achieve the effect of faking. With the development of laparoscopic technology and the improvement of aesthetic efficacy, people’s thinking is changing to minimally invasive surgery. Plastic surgeons have cleverly combined laparoscopic technology with vaginal reconstruction to overcome the disadvantages of traditional intestinal transplantation that requires an open abdomen. It has the advantages of small incision, less pain and quick recovery, and can meet the patient’s demand for physical beauty, which makes ileovaginoplasty more popular. 2.Vaginoplasty of oral mucosa If there is a risk of intestinal adhesion and intestinal obstruction in ileocecal vaginoplasty, then vaginal reconstruction by cutting oral mucosa is the safest, easy, minimally invasive and effective method. The vaginal mucosa and the oral mucosa have the same morphology and are soft, smooth and elastic. By removing the oral mucosa in a dotted pattern, the area of each wound is reduced to facilitate healing, and the amount of mucosa needed to cover the cavernous wound of the artificial vagina is increased. However, the area of oral mucosa is not enough to completely cover the cavity and needs to be improved. Therefore, tissue engineering techniques were applied to make vaginal reconstruction possible, i.e., a small amount of oral mucosal cells were expanded by in vitro culture and grown along a designed scaffold model to achieve a minimally invasive reconstruction and functional reconstruction of the human vagina. The external genitalia of men and women are the organs of human sexual intercourse and racial reproduction. Sexual organs and secondary sexual characteristics have an important position in the aesthetic process of sexual aesthetics, so plastic surgery of the genitalia should ensure both perfect appearance and maintenance of good sexual function. The unity of form and function is a principle that needs to be followed in plastic surgery, and surgery based on plastic purposes needs to be more minimally invasive. With the development of laparoscopic technology and tissue engineering techniques, better vaginal tissue replacement materials and minimally invasive surgical methods will be available and will provide new hope for clinical patients.