OBJECTIVE: To select a satisfactory surgical approach in vaginoplasty with minimum injury and maximum effectiveness. METHODS: From January 1997 to December 1998, 86 cases of congenital absence of vagina were treated by three types of vaginoplasty, using abdominal skin graft, fetal skin graft and vulvar-inguinal skin flap respectively. The duration of operation and hospitalization, the wound healing of donor site, as well as the moist sensation of the artificial vagina and the sexual life quality were compared among the three types of vaginoplasty. RESULTS: Compared with those by abdominal skin graft and vulvar-inguinal skin flaps, the vaginoplasty by fetal skin graft had the shortest surgical duration (P lt; 0.01); the duration of hospitalization with fetal skin grafting was shorter than that of abdominal skin grafting (P lt; 0.01) but almost the same as that of vulvar-inguinal skin transferring (P gt; 0.05). The fetal skin grafting had minimum injury. Moreover, artificial vagina by fetal skin grafting had the best moist sensation and the most satisfactory sexual life quality (P lt; 0.01). CONCLUSION: In view of the minimum injury and maximum mimic of nature vagina, the vaginoplasty by fetal skin graft is the most ideal approach among the three types of vaginoplasty investigated in this trial.