Jasonni VM1, La Marca A, Naldi S, Matonti G, D'Anna R. Abstract OBJECTIVE: To present the results obtained in 104 cases of vaginal aplasia resolved with self-dilatation or with surgical procedures such as the McIndoe or Williams operations. DESIGN: Retrospective study. SETTING: Departments of obstetrics and gynecology of universities in Bologna, Modena, and Messina, Italy. PATIENT(S): One hundred four cases of vaginal aplasia. INTERVENTION(S): Self-dilatation and surgical procedures such as the McIndoe or Williams operations. MAIN OUTCOME MEASURE(S): Outcome of the treatment. RESULT(S): From 1977 to 2002, 104 cases of vaginal agenesis were treated. The mean age of the treated patients was 16.5 years old (range, 13-18 years). After 6 months of self-dilatation, 41 subjects obtained a new cavity of about 10-12 cm in length. In 14 patients, a space ranging from 3 to 5 cm was obtained. The technique failed in 49 patients. Fourteen patients underwent the Williams surgical procedure, while the remaining 49 patients underwent to the McIndoe procedure. All patients were successfully treated, and the only complication, a rectovaginal fistula that was repaired, occurred in one case of the McIndoe operation. CONCLUSION(S): Self-dilatation should be the first approach because of its high success rate; the Williams surgical approach should be chosen when self-dilatation partially fails or when previous surgical attempts are unsuccessful. Finally, the McIndoe procedure and its variants should be used when self-dilatation completely fails.