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

Creating a Vagina: Dilation and Surgical Options

At a Glance

The recommended first step for creating a neovagina with MRKH syndrome is non-surgical vaginal dilation, which is highly effective and uses your own natural tissue. If dilation is unsuccessful or not preferred, surgical procedures are available, though they also require post-surgery dilation.

For many people with MRKH syndrome, the decision of if, when, and how to create a neovagina is one of the most significant steps in their care. It is important to know that there is no “medical emergency” to start this process [1]. The most critical factor for success—whether you choose a non-surgical or surgical route—is your own emotional readiness and maturity [2][3].

Non-Surgical Dilation: The First-Line Choice

The medical “standard of care” (the recommended first step) is non-surgical vaginal dilation, often called the Frank’s method [4][5]. This approach uses small, smooth plastic or silicone tubes (dilators) to gradually stretch the existing vaginal dimple or pouch over time [5].

Why it is the first choice:

  • Effective: It has a very high success rate (over 90% in motivated patients) [4].
  • Natural: The new vaginal lining is made of your own natural skin, which is naturally lubricated and sensitive [4].
  • Low Risk: It avoids the risks of anesthesia, scarring, and surgery [1][5].

Success with dilation depends entirely on your commitment to a daily routine. Most protocols involve using a water-based lubricant and sitting comfortably for 10–30 minutes, once or twice a day, and applying gentle pressure [5]. This process typically takes anywhere from a few months to a year to achieve full depth [4]. Many patients also find that Pelvic Floor Physical Therapy (PFPT) is an incredibly helpful addition, as specialized therapists can teach you how to relax the pelvic muscles to make dilation easier and more comfortable [1]. Because this requires focus and patience, doctors recommend starting only when you feel ready and motivated [2].

Surgical Options

If dilation is not successful or if a patient chooses not to pursue it, several surgical options are available. All of these procedures still require some dilation afterward to keep the new space open and flexible [6][7].

  • The Davydov Procedure: This is a “peritoneal pull-through” technique, often done laparoscopically (through small “keyhole” incisions in the abdomen). Surgeons use the peritoneum (the smooth lining of the abdominal cavity) to create the new vaginal walls [8][9].
  • The Vecchietti Procedure: This uses a mechanical device to apply constant, gradual upward traction on the vaginal dimple. It is important to know that placing this traction device requires laparoscopic abdominal surgery, and patients typically stay in the hospital for several days to manage pain while the traction is occurring [6][10].
  • The McIndoe Procedure: This is a classic method where a space is surgically created, and then lined with a skin graft (usually taken from the thigh or buttocks) or a synthetic material [11][12]. Because this involves a skin graft, recovery includes healing at both the vaginal site and the donor site (which may leave a scar), requiring careful postoperative rest and wound care [12].

Outcomes and Sexual Health

Whether you choose dilation or surgery, the functional outcomes are generally excellent. Most individuals report that their neovagina provides satisfactory anatomical depth and allows for comfortable sexual activity [13][14]. Studies show that sexual function scores for people with MRKH after treatment are often comparable to those in the general population [13][15].

It is helpful to remember that a neovagina might feel slightly different—for example, it may have different levels of natural lubrication or blood flow compared to a natal vagina [16]. However, with time and the support of your care team, most patients find that their physical and emotional well-being significantly improves after treatment [13][2]. Your doctors and therapists are there to support you through every step of this personal decision.

Common questions in this guide

Is there a medical rush to create a vagina if I am diagnosed with MRKH?
No, there is no medical emergency to start the process of creating a vagina. The most important factor for success is your own emotional readiness and maturity. You should only begin the process when you feel personally prepared.
What is the first recommended step for creating a neovagina?
The medical standard of care is non-surgical vaginal dilation, also known as the Frank's method. This involves using small, smooth dilators to gradually stretch the existing vaginal dimple or pouch over time, creating natural depth without surgery.
Will I still need to use dilators if I choose to have surgery?
Yes, even if you undergo a surgical procedure like the Davydov, Vecchietti, or McIndoe method, you will still need to use dilators afterward. This is necessary to keep the newly created space open and flexible while you heal.
Can physical therapy help if dilation is uncomfortable?
Yes, working with a specialized pelvic floor physical therapist can be incredibly helpful. They teach you techniques to relax your pelvic muscles, which can make the daily dilation process much easier and more comfortable.
Will I be able to have comfortable sexual activity after treatment?
Yes, functional outcomes are generally excellent with both dilation and surgery. Most patients achieve satisfactory anatomical depth and report comfortable, enjoyable sexual activity that is comparable to the general population.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Based on my specific anatomy, do I have a 'starting' vaginal pouch that makes dilation more likely to succeed?
  2. 2.What is the success rate for non-surgical dilation at your clinic, and what support do you provide during the process?
  3. 3.Can you refer me to a Pelvic Floor Physical Therapist who can help me if I experience tension or pain during dilation?
  4. 4.If I choose to wait a few years before starting any treatment, will that make the process more difficult later?
  5. 5.Which surgical procedure do you have the most experience with, and what is the typical hospital stay and recovery time?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

References

References (16)
  1. 1

    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
  2. 2

    Effectiveness of non-surgical interventions to improve health and well-being in women living with Mayer-Rokitansky-Kuster-Hauser syndrome: A systematic review.

    Baby A, Pallam MC, Hayter M

    Journal of advanced nursing 2024; (80(6)):2167-2201 doi:10.1111/jan.15976.

    PMID: 37994266
  3. 3

    The need to integrate mental health treatment into the care of Mayer-Rokitansky-Küster-Hauser.

    Davoudian T, Hills E

    F&S reports 2025; (6(2)):116-119 doi:10.1016/j.xfre.2025.03.008.

    PMID: 40620385
  4. 4

    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
  5. 5

    Treatment of vaginal agenesis in Mayer-Rokitansky-Küster-Hauser syndrome in Denmark: a nationwide comparative study of anatomical outcome and complications.

    Herlin M, Bay Bjørn AM, Jørgensen LK, et al.

    Fertility and sterility 2018; (110(4)):746-753 doi:10.1016/j.fertnstert.2018.05.015.

    PMID: 30196972
  6. 6

    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
  7. 7

    A case of neovagina surgical creation using the uterine cervix remnant in a patient with Mayer-Rokitansky-Küster-Hauser syndrome.

    Medvediev M, Spesyvtsev D, Pokrovenko D

    Fertility and sterility 2021; (116(5)):1420-1422 doi:10.1016/j.fertnstert.2021.06.030.

    PMID: 34330430
  8. 8

    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; doi:10.1016/j.jmig.2026.01.022.

    PMID: 41529741
  9. 9

    Pioneering robotic-assisted Davydov vaginoplasty for Mayer-Rokitansky-Küster-Hauser syndrome.

    Panwar VK, Heda A, Singh G, Bahadur A

    BMJ case reports 2025; (18(1)) doi:10.1136/bcr-2024-262794.

    PMID: 39842904
  10. 10

    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
  11. 11

    Neovagina creation methods in Müllerian anomalies and risk of malignancy: insights from a systematic review.

    Fedele F, Bulfoni A, Parazzini F, Busnelli A

    Archives of gynecology and obstetrics 2024; (309(3)):801-812 doi:10.1007/s00404-023-07086-6.

    PMID: 37466686
  12. 12

    Indigenous technique of fabricating vaginal mould for vaginal reconstruction and uterine drainage in McIndoe vaginoplasty using 10 ml syringe.

    Mishra B, Janavar G, Pradeep Y, et al.

    Indian journal of plastic surgery : official publication of the Association of Plastic Surgeons of India 2016; (49(1)):76-80 doi:10.4103/0970-0358.182230.

    PMID: 27274126
  13. 13

    Long Term Findings Concerning the Mental and Physical Condition, Quality of Life and Sexuality after Laparoscopically Assisted Creation of a Neovagina (Modified Vecchietti Technique) in Young MRKHS (Mayer-Rokitansky-Küster-Hauser-Syndrome) Patients.

    Rall K, Schenk B, Schäffeler N, et al.

    Journal of clinical medicine 2021; (10(6)) doi:10.3390/jcm10061269.

    PMID: 33803863
  14. 14

    Sexual and Psychosocial Outcome After Neovaginoplasty Using Interceed in Females with Mayer-Rokitansky-Küster-Hauser Syndrome: A Case-Control Study.

    Jha S, Singh S

    Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC 2022; (44(8)):926-930 doi:10.1016/j.jogc.2022.03.018.

    PMID: 35489673
  15. 15

    Long-term Results of Sexual Function and Body Image After Vaginoplasty With Acellular Dermal Matrix in Women With Mayer-Rokitansky-Küster-Hauser Syndrome.

    Mao M, Zhang Y, Fu H, et al.

    Journal of minimally invasive gynecology 2024; (31(1)):37-42 doi:10.1016/j.jmig.2023.10.003.

    PMID: 37820829
  16. 16

    Sexual response in women with Mayer-Rokitansky-Küster-Hauser syndrome with a nonsurgical neovagina.

    Both S, Kluivers K, Ten Kate-Booij M, Weijenborg P

    American journal of obstetrics and gynecology 2018; (219(3)):283.e1-283.e8 doi:10.1016/j.ajog.2018.07.012.

    PMID: 30017684

This page is for informational purposes only and does not replace professional medical advice. Always consult your gynecologist or healthcare team about the best neovagina options for your specific anatomy and emotional readiness.

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