Various grafting materials have been utilized in vaginal surgery. Unlike autologous skin flaps and grafts, xenografts do not require tissue harvesting. In addition, these acellular matrices allow for the in-growth of host cells and become indistinguishable from surrounding tissues. In this video, we demonstrate the application of porcine small intestinal submucosa (SIS) matrix graft in two pediatric vaginoplasty cases. The first case is an 18 year old female with prior surgical repair of an urogenital sinus. The vaginal portion subsequently became scarred and obliterated. Following lysis of vaginal adhesions and establishing a patent vaginal canal, SIS graft was sutured to the vaginal mucosa to prevent further scarring and constriction of the neovagina. The second case is a 13 year old female with a transverse vaginal septum. The vaginal septum was resected and SIS graft was applied to bridge the gap in the vaginal mucosa. In both cases, a vaginal mold was inserted and kept in place for 7 days to allow the graft to fully incorporate into the repair. Following removal of the mold, patients are instructed to perform daily vaginal dilation to prevent further narrowing.