Children with abnormal genitalia associated with intersex anomalies or cloacal malformations require vaginal reconstruction. Although many procedures using skin grafts, skin flaps, and intestinal segments have been described, they all have disadvantages. In the present study 12 patients with genital defects who required vaginoplasty underwent surgery using a new technique using bilateral pudendal-thigh flaps based on the posterior labial artery. There were six patients with congenital adrenal hyperplasia (CAH), three with vaginal atresia, two with cloacal deformities, and one with testicular feminizing syndrome. Four of the CAH patients and the two with cloaca underwent vaginoplasty as second-stage procedures. All other cases were treated with one-stage operations. This method of vaginoplasty can be combined with correction of other associated abnormalities, and it has proved to be simple and reliable with satisfactory functional and cosmetic results.