Colovaginoplasty is associated with the best long-term functional results for vaginal replacement because of its greater length and natural lubrication. This video describes my technique of colovaginoplasty in a 13 year old female with testicular feminization syndrome. The operation is carried out through a combined abdominal-perineal approach, in which the midsigmoid colon is isolated on its blood supply and mobilized transabdominally to the introitus.