The major steps in vaginoplasty are orchiectomy, penile amputation, creation of the neovaginal cavity with lining, and reconstruction of urethral meatus, labia, and clitoris. During pedicled intestinal transfer, an intestinal segment is transferred in a dissected cavity between the bladder and rectum. The bowel harvest is performed by a total laparoscopic technique. It is imperative to create the labia majora and minora, the clitoris, and a clitoral hood to achieve the physiologic and aesthetic equivalent of female external genitalia. Intestinal vaginoplasty seems to be associated with a low rate of adverse events. Life-long vaginal hygiene and dilatation is recommended.