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PubMed This is a summary of 16 peer-reviewed journal articles Updated
Gynecology

Surgical Options: Choosing the Right Path for You

At a Glance

Surgery for MRKH (neovaginoplasty) is an effective option if non-surgical dilation is unsuccessful. Common procedures include the Davydov, Vecchietti, and intestinal methods. Except for bowel vaginoplasty, patients must still commit to post-operative dilation to maintain the vaginal canal.

While non-surgical dilation is the first choice for most, surgery—known as neovaginoplasty—is an effective option if dilation isn’t possible, preferred, or successful [1][2]. Choosing surgery is a significant decision, and understanding the different techniques, pain management, and recovery requirements can help you decide which path is right for you.

Common Surgical Techniques

There are several ways to surgically create a vaginal canal. The most common methods today are:

  • The Davydov Procedure: This is a laparoscopic (minimally invasive) surgery that uses the peritoneum—the smooth, natural lining of your abdominal cavity—to line the new vaginal canal [3]. It is often favored because the peritoneal tissue naturally produces its own lubrication and typically results in excellent anatomical length [4][5].
  • The Vecchietti Procedure: This is a “traction” method. A small plastic bead is placed against the vaginal dimple and connected to threads that are pulled upward through the abdomen using laparoscopic tools [6]. Over about 7 to 10 days, the threads are tightened, gradually stretching your own tissue inward to create the canal [7]. Pain Management: Because continuous traction can be painful, patients are kept in the hospital during this stretching phase and pain is strictly managed, often with an epidural or intravenous (IV) pain medications [8].
  • Intestinal (Bowel) Vaginoplasty: In this major surgery, a surgeon removes a small section of the bowel (usually the colon) and relocates it to create the vaginal canal [8]. Because the bowel tissue already has a natural opening (lumen) and produces significant lubrication, this method has a distinct advantage: it typically does not require routine post-operative dilation [8].
  • The McIndoe Procedure: This traditional technique creates a space and lines it with a skin graft, usually taken from the hip or buttock [9]. It involves a second surgical site and may have a higher risk of the canal narrowing over time [10].

Life After Surgery: Post-Operative Dilation

It is a common misconception that all surgeries “replace” dilation. In reality, post-operative dilation is mandatory for the long-term success of graft, peritoneal (Davydov), and traction (Vecchietti) methods [11]. Without regular dilation or frequent sexual intercourse, the body’s natural healing process can cause the new canal to narrow or close (a process called stenosis) [12][13].

Most patients using these methods will need to use a vaginal “mold” or dilator almost constantly for the first few weeks after surgery, gradually moving to intermittent use as the tissue heals [12]. As noted above, intestinal vaginoplasty is the general exception to this rule [8].

Surgical Risks and Recovery Timelines

Recovery varies by procedure. Laparoscopic methods (Davydov, Vecchietti) generally require a few days in the hospital and a few weeks of rest before resuming normal activities [3]. Intestinal vaginoplasty is a more extensive abdominal surgery with a longer recovery period and involves risks specific to the bowel [8].

Potential complications for any neovaginoplasty include strictures (narrowing of the canal), bleeding, or, rarely, fistulas (abnormal connections to the bladder or bowel) [14][13]. Because MRKH is rare, these operations should only be performed at specialized, high-volume centers to minimize these risks [9][14].

Research shows that both surgical and non-surgical methods lead to similar levels of sexual satisfaction and quality of life [15][2]. The “best” method is the one that aligns with your personal goals and your readiness to commit to the necessary aftercare [2][16].

Common questions in this guide

Does surgery for MRKH mean I won't have to dilate anymore?
For most surgeries, including the Davydov and Vecchietti procedures, you must still dilate regularly after surgery to prevent the new canal from narrowing. The primary exception is intestinal vaginoplasty, which typically does not require routine post-operative dilation.
What is the Davydov procedure for MRKH?
The Davydov procedure is a minimally invasive surgery that uses the natural lining of your abdominal cavity, called the peritoneum, to line the new vaginal canal. This tissue naturally produces its own lubrication and often results in excellent anatomical length.
Is the Vecchietti procedure painful?
The Vecchietti procedure uses continuous traction to stretch tissue over 7 to 10 days, which can be painful. Patients usually stay in the hospital during this phase so that pain can be strictly managed with epidurals or intravenous medications.
What are the risks of MRKH neovaginoplasty surgery?
Potential complications include strictures or narrowing of the canal, bleeding, and rarely fistulas, which are abnormal connections to the bladder or bowel. Because MRKH is rare, surgery should only be performed at specialized, high-volume medical centers.
How does an intestinal vaginoplasty work?
An intestinal or bowel vaginoplasty is a major surgery where a surgeon uses a small section of your colon to create the vaginal canal. Because bowel tissue produces its own lubrication and is already an open tube, this method typically does not require post-operative dilation.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.How many of these specific procedures do you perform each year?
  2. 2.What is your personal success rate for this surgery, and how do you define success (e.g., vaginal length vs. patient satisfaction)?
  3. 3.Can you explain why you recommend one surgical technique over another for my specific anatomy?
  4. 4.What does the immediate recovery look like, and how is pain managed while in the hospital?
  5. 5.What are the long-term risks, like strictures or fistulas, and how do you monitor for them?

Questions For You

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References

References (16)
  1. 1

    Treatment of patients with Mayer-Rokitansky- Küster-Hauser syndrome in a tertiary hospital.

    Ng K, Ip PNP, Yiu KW, et al.

    Hong Kong medical journal = Xianggang yi xue za zhi 2020; (26(5)):397-403 doi:10.12809/hkmj208467.

    PMID: 33060366
  2. 2

    Methods for neovagina creation in women with Mayer-Rokitansky-Küster-Hauser syndrome for subsequent uterus transplantation.

    Chmel R, Pastor Z, Novackova M, et al.

    Biomedical papers of the Medical Faculty of the University Palacky, Olomouc, Czechoslovakia 2021; (165(4)):360-366 doi:10.5507/bp.2021.049.

    PMID: 34446938
  3. 3

    Modified Davydov Neovaginoplasty in Patients With Mayer-Rokitansky-Kuster-Hauser Syndrome: Outcomes From an Extensive Surgical Experience.

    Benini V, Parma M, Grecchi G, et al.

    Journal of minimally invasive gynecology 2026; (33(5)):590-597 doi:10.1016/j.jmig.2026.01.022.

    PMID: 41529741
  4. 4

    Satisfactory Outcome of Various Novel Modified Laparoscopic Neovaginoplasty Using Autologous Peritoneal Graft.

    Meutia AP, Ksyatria Y, Priyatini T, et al.

    Gynecology and minimally invasive therapy 2024; (13(1)):48-52 doi:10.4103/gmit.gmit_33_23.

    PMID: 38487607
  5. 5

    Laparoscopic Davydov's Colpopoiesis for a Case of Mayer-Rokitansky-Kuster-Hauser (MRKH) Syndrome.

    Samantray SR, Mohapatra I, Harshini N

    Cureus 2021; (13(3)):e13974 doi:10.7759/cureus.13974.

    PMID: 33884233
  6. 6

    Optimizing the Laparoscopic Vecchietti Procedure: Tips and Tricks.

    Sinha A, Woll A, Kisby CK

    Urogynecology (Philadelphia, Pa.) 2025; (31(4)):465-468 doi:10.1097/SPV.0000000000001613.

    PMID: 39908410
  7. 7

    Surgical Correction of Vaginal Agenesis via Modified Laparoscopic Vecchietti Procedure.

    Esencan E, St Martin B, Harmanli O, Vash-Margita A

    Journal of pediatric and adolescent gynecology 2023; (36(6)):556-559 doi:10.1016/j.jpag.2023.06.004.

    PMID: 37354985
  8. 8

    [Comparison study between Vecchietti's and Davydov's laparoscopic vaginoplasty in Mayer-Rokitansky-Küster-Hauser syndrome].

    Dong X, Xie Z, Jin H

    Zhonghua fu chan ke za zhi 2015; (50(4)):278-82.

    PMID: 26080940
  9. 9

    ACOG Committee Opinion No. 728: Müllerian Agenesis: Diagnosis, Management, And Treatment.

    Obstetrics and gynecology 2018; (131(1)):e35-e42 doi:10.1097/AOG.0000000000002458.

    PMID: 29266078
  10. 10

    From Avoidance to Empowerment: Coping Strategies in Women With Müllerian agenesis (MRKH) After McIndoe Reconstruction: A Descriptive Phenomenological Study.

    Güner P, Ulukaya T

    Journal of pediatric and adolescent gynecology 2026; (39(1)):101-108 doi:10.1016/j.jpag.2025.10.013.

    PMID: 41151671
  11. 11

    Laparoscopic Davydov Procedure for the Creation of a Neovagina in Patients with Mayer-Rokitansky-Kuster-Hauser Syndrome: Analysis of 7 Cases.

    Takahashi K, Nakamura E, Suzuki S, et al.

    The Tokai journal of experimental and clinical medicine 2016; (41(2)):81-7.

    PMID: 27344998
  12. 12

    Effects of different vaginal mould use approaches after vaginoplasty with artificial dermis in patients with Mayer-Rokitansky-Küster-Hauser syndrome.

    Wang W, Chen F, Cheng J, et al.

    The Journal of international medical research 2021; (49(2)):300060521990519 doi:10.1177/0300060521990519.

    PMID: 33530790
  13. 13

    Stenosis of Sigmoid Neovagina with Subsequent Pelvic Infection and Surgical Excision.

    King T, Abam C, Trautner E, et al.

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    PMID: 40316006
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    3-year-old with Mayer-Rokitansky-Küster-Hauser syndrome and anorectal malformation: A case report.

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    Sexual function and quality of life after the creation of a neovagina in women with Mayer-Rokitansky-Küster-Hauser syndrome: comparison of vaginal dilation and surgical procedures.

    Kang J, Chen N, Song S, et al.

    Fertility and sterility 2020; (113(5)):1024-1031 doi:10.1016/j.fertnstert.2020.01.017.

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    Comprehensive management of Mayer-Rokitansky-Küster-Hauser syndrome management: A case report.

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This page provides educational information about MRKH surgical options. Always consult with a specialized gynecologic surgeon to determine the best treatment plan for your specific anatomy.

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