There are many reconstructive options for the perineum, including allowing the wound to heal by secondary intention, local random or axial pattern flaps, regional flaps and free flaps. Three structures need to be addressed: tissue to reconstruct the pelvic floor, tissue to fill the deadspace and external skin cover. Hypospadias is the most common congenital abnormality of the penis, characterized by: a proximally located urethral meatus, ventral curvature of the shaft and a dorsally hooded prepuce. The Snodgrass technique is the most common procedure used to correct a distal hypospadias and the Bracka two‐stage technique is favoured for proximal hypospadias. Acquired vaginal and penile defects are commonly caused by oncologic resections, although other causes include trauma and infection. In cases of vaginal agenesis where a dimple of vaginal mucosa is present, non‐surgical techniques are preferred to surgical creation of a neovagina. For partial and total vaginal reconstructions, the pedicled rectus abdominis myocutaneous flap is the usual method. Other options include the pudendal thigh flap and anterolateral thigh flap, as well as intestinal conduits. Subtotal penal reconstruction often involves skin grafting of the shaft or glans while total penile reconstruction usually involves treatment with a local or regional flap.