The McIndoe vaginoplasty operation is a well described surgical procedure for the creation of a neovagina. Aside from congenital vaginal agenesis, other indications for this procedure include radical vulvo-vaginectomy for malignancy, as well as simple vaginectomy for dermatologic conditions such as extensive vaginal intraepithelial neoplasia, vaginal condyloma or erosive lichen planus unresponsive to medical or minor surgical therapy. A drawback to the standard McIndoe technique is that it requires the harvesting of a split thickness skin graft, and prolonged, and many times, painful healing of the donor site by secondary intention. We demonstrate an alternative to this procedure, the use of an allograft as apposed to a split thickness skin graft. Alloderm is an acellular dermal matrix graft derived from human donor tissue that is treated to remove both the epidermis and all cellular material associated with tissue rejection and graft failure. This process leaves behind a tissue matrix comprised of collagen and a basement membrane which supports tissue ingrowth of surface epithelial cells. This video demonstrates a modification of the McIndoe operative technique, with construction of a neovagina by cavitation, and placement of an acellular dermal matrix allograft, in a patient with congenital vaginal agenesis.