To assess the technical feasibility and functional results of sigmoid colon vaginoplasty using a modified technique. Retrospective descriptive analysis. Referral centre. A method for creating an artificial vagina was applied in 13 women for the following indications: true hermaphrodite (n = 1), gender dysphoria (n = 2), Müllerian dysgenesis (n = 10). A method for sigmoid vaginoplasty was devised whereby transection of the inferior mesenteric artery proximal to the first sigmoid branch provides immediate mobility for the sigmoid colonic segment to reach the introitus (with adequate nourishment from the middle and inferior rectal vascular systems). Assessment of sexual function after a follow up period of 1 to 19 years. Twelve women reported a satisfactory result. Three of these were lost to follow up after one year, and the others report for regular assessment. Mild stenosis at the muco-cutaneous anastomosis, which may occur after failed perineal procedures, appears to be amenable to daily dilatations until the women become sexually active. In one woman the prosthesis had to be removed on account of severe pelvic floor fibrosis as a result of previous abdomino-perineal surgery at the age of seven. Another woman presented with a postcoital vesico-vaginal fistula after a previous McIndoe procedure; the tear at the base of the bladder was repaired and buttressed with a sigmoid vagina which is now functioning satisfactorily after 19 years. The creation of a sigmoid vagina which is vascularised by the middle and inferior rectal arterial systems appears to be an acceptable procedure for vaginal agenesis, acquired vaginal loss or sexual reassignment.