Purpose of Review <p>The goal of this work is to review the most common techniques for surgical vaginoplasty. Specifically, this review delves into the history of surgical approaches to vaginal agenesis, including the landmark studies that first described the approaches we still use today. Next, we describe each of the three most commonly used techniques – the McIndoe, the Vecchietti, and the Davydov – including a review of the major case series published on each technique, and supplemented by medical illustrations. Lastly, we outline the most exciting innovations in the treatment of vaginal agenesis.</p> Recent Findings <p>The field of vaginal reconstruction is experiencing exciting new growth in the realms of increasingly minimally invasive approaches, tissue engineering, and new graft materials or strategies for neovaginal creation.</p> Summary <p>Throughout history, there have been numerous approaches to the clinical conundrum of vaginal agenesis. There are pros and cons to each of the three most commonly used techniques. Lastly, innovations in the realm of bioengineering are advancing this field and creating exciting new possibilities for the care of these patients.</p>