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Background Aim Materials and methods Results Conclusion Vaginal aplasia or hypoplasia often requires the creation of a neovagina using vaginal dilation therapy, vaginoplasty surgery, or a combination of both. However, the absence of validated guidelines and the controversy surrounding vaginoplasty surgery have limited our understanding of the long‐term outcomes and impact on quality of life and psychosexual functioning for women with a short or absent vagina. This study provides valuable insights into the Australian context, reflecting the treatment approaches and long‐term psychosocial outcomes for this patient group.This study aimed to assess the long‐term effects of vaginal dilation, with or without vaginoplasty surgery, on quality of life and psychosexual functioning in women diagnosed with a short or absent vagina.A mixed‐methods design was employed, utilising validated psychometric tools and a semi‐structured interview. The study included patients with disorders of sex development aged above 16 who underwent vaginal dilator therapy between 2012 and 2020, as well as healthy age‐matched controls. The research was conducted at a single tertiary hospital in Sydney, NSW, Australia.The questionnaire was completed by 30 participants, including 11 non‐surgical cases, four surgical cases, and 15 controls. The mean age at inclusion was 30.8 ± 14.1 years. The non‐surgical group exhibited significantly higher scores indicating a greater ‘need for help’ compared to the surgical group (30.0 ± 19.3 and 4.5 ± 9.0; P = 0.0121). No other statistically significant differences were observed between the two groups.Choice of treatment should consider various factors, including patient preference and responsiveness to treatment. These findings emphasise the importance of personalised care in the Australian context and highlight the need for further research, particularly with larger and more homogenous sample sizes, to enhance clinical decision‐making in this population. [ABSTRACT FROM AUTHOR]