Although conservative therapy through vaginal dilation is still recommended as the first-line treatment for vaginal agenesis in patients affected by Mayer-Rokitansky-Küster-Hauser syndrome,1 several surgical options are available and well supported.2

However, long-term outcomes of surgical interventions are lacking, and the different types of vaginoplasty have not yet been compared with each other. Therefore, the choice of the most suitable intervention remains controversial and strongly related to the preference and experience of the surgeon.

Nonetheless, the goal of any vaginoplasty procedure is to obtain a well-epithelialized, trophic, enjoyable, and satisfactory neovagina that could be suitable for penetrative vaginal intercourse if desired by the patient.3

Several surgical procedures to treat Mayer-Rokitansky-Küster-Hauser syndrome have been developed, such as McIndoe vaginoplasty,4 intestinal vaginoplasty,5 Vecchietti vaginoplasty,6 Davydov vaginoplasty,7 and implantation of a buccal mucosal graft, amnion graft, or various other allografts.1 Among the most frequently adopted procedures, the McIndoe technique uses a split-thickness skin graft to cover the neovaginal canal, whereas the Vecchietti vaginoplasty involves gradual stretching of the patient's own vaginal skin and mucosa, and the Davydov technique contemplates the use of the peritoneum.

As previously mentioned, only a few studies have reported long-term results,8 and even fewer studies have compared the results among the various techniques.

Therefore, the aim of the current study was to describe the histological features of neovaginal epithelia and their evolution over time in 36 women affected by Mayer-Rokitansky-Küster-Hauser syndrome, according to the surgical technique.