[citation needed] The main causes are Müllerian agenesis and complete androgen insensitivity syndrome.

[1] In order to facilitate sexual intercourse, the main treatments are self-dilation methods (using intra-vaginal cylinders or inflatable expanders (vaginal stents) of increasing size) and surgical vaginoplasty to lengthen the vagina.

[1] Self-dilation has a high success rate, estimated at 75%, and is usually the first-line treatment due to low surgical invasiveness.

The vaginoplasty is performed around the inflatable expander which maintains the neovagina against the pelvic wall after the surgery and favors the process of microscopic neovascularization while reducing the risks for hematoma.

[1] After vaginoplasty, available evidence suggests that continued self-dilation is needed to maintain the patency in periods of coital inactivity.