To report a 12 years experience with 54 patients affected by congenital or acquired, total or partial, absence of the vagina, treated with colovaginoplastyFrom 1995 to 2006, 54 patients from 5 to 29 years (average 16.4) with vaginal inadequacy were treated utilizing the sigmoid colon. Total vaginal replacement was done in 53, 1 patient received a partial vaginoplasty. Thirty-four were affected by Mayer-Rokitansky syndrome, 18 by androgen–insensitivity-syndrome, 1 by cloacal exstrophy, and 1 by acquired total vaginal and urethral disruption. Vaginal dilations were utilised in the majority of cases and discontinued within 1 year.The short-term morbilidy was minimal. At the long-term follow-up, in all the patients the neovagina had a good looking introitus. No stones or tumour were reported. We experienced 1 case of diversion colitis. Introitoplasty for distal stenosis or cosmetic reasons was performed in 6 patients and another 6 were treated with dilation. Mucus discharge decreased significantly within 4 months of surgery but represented a problem in 9 cases. Twenty-seven patients have an active and, reportedly, satisfactory sex life. Six couples have already adopted children. Four patients married after reconstruction.Colovaginoplasty showed excellent results in our series. The complication rate was acceptable. This procedure seems to ensure a good quality of general and sexual life. Adenocarcinoma in the sigmoid neovagina has been reported and follow up by periodic vaginoscopy is necessary. Diversion-colitis of the colo-vagina is rare in our series and is avoidable by regular vaginal irrigation, prevention of vaginal stenosis and creating a moderately short colo-vagina.