Introduction and Hypothesis <p>Mayer–Rokitansky–Küster–Hauser syndrome (MRKH) is a congenital disorder characterized by partial or complete agenesis of the uterus and upper two-thirds of the vagina, with preserved ovarian function and normal external genitalia. This study aimed to evaluate the clinical and therapeutic profiles of patients with MRKH treated at a university hospital and to compare vaginal length outcomes between surgical and nonsurgical interventions during 1 year of follow-up.</p> Methods <p>A retrospective review was performed of medical records from patients followed at the Genital Malformations Outpatient Clinic of a university hospital between January 2010 and February 2020. Data collected included age, presenting complaint, treatment modality (vaginal dilation or neovaginoplasty), vaginal length at different follow-up periods, and vaginal intercourse before and after treatment.</p> Results <p>Among 151 patients evaluated, 67 (44.4%) were diagnosed with MRKH syndrome. Vaginal length outcomes were analyzed in 49 treated patients, including 30 who underwent vaginal dilation and 19 who underwent neovaginoplasty, without patient randomization. Both approaches significantly increased vaginal length, with similar final measurements after 1 year, although surgery produced greater early gains. Vaginal intercourse also increased substantially in both groups after treatment, with no significant differences between groups.</p> Conclusions <p>Both surgical and nonsurgical approaches were associated with increased vaginal length throughout follow-up. In this retrospective cohort, patients with available 1-year follow-up demonstrated similar final vaginal lengths, although surgery was associated with greater early gains. Considering its lower invasiveness, vaginal dilation remains an appropriate first-line treatment option.</p>