Long-term results obtained through different methods of treatment were analysed in a series of 39 patients with congenital absence of the vagina. Thirty-three patients were treated with the McIndoe skin graft technique, 6 of them by the modification of Counseller and Davis. In three patients the neovagina was grafted with amnion and three were treated with the Frank nonoperative method. The result was graded good in 27 and satisfactory in 11 patients. In one patient the McIndoe operation resulted in a complete failure. There was no obvious difference between the results obtained by different methods except for the modification of Counseller and Davis which gave a good result in all cases. Judging from the general appearance and cytological pattern of the artificial vagina a more physiological result was achieved in patients with an amnion graft as compared with those with a skin graft. The nonoperative method is suggested as the first alternative in the treatment of patients with congenital absence of the vagina.