BACKGROUND: About 430,000-1,000,000 Gender Dysphoria- and Mayer-Rokitanksy-Küster-Hauser-patients undergo vaginoplasty each year. Various surgical procedures are available, but direct comparisons are lacking. This inhibits well-informed decision making by patients and healthcare professionals. OBJECTIVES: Highlight information gaps, weaknesses and strengths of todays vaginoplasty techniques. SEARCH STRATEGY: A systematic search in Medline, EMBASE, Web of Science and Scopus until March 8, 2022 was conducted, by PICO method and PROSPERO registration. SELECTION CRITERIA: Original retrospective studies on complete neovaginal creation in adult Gender Dysphoria- and Mayer-Rokitanksy-Küster-Hauser-patients and discussing anatomical outcome, Quality of Life, satisfaction, sexual function, complications and/or complaints. DATA COLLECTION AND ANALYSIS: Data was extracted and methodological quality and potential bias were assessed. The 95% confidence intervals were calculated with DerSimonian and Laird random-effects. MAIN RESULTS: A total of 47 articles were eligible. Surgery took 198 minutes with 10.2 cm vaginal length. Major complications included 5% hemorrhage, 1% gastrointestinal complications, 1% prolapse, 3% tissue necrosis and 6% stenosis, with 31% revisions. Patients reported 25% excessive discharge, 6% pain, 11% fecal- and 17% urinary issues and one case of hair growth. Patients also reported 95% aesthetic- and 93% anatomical satisfaction, 10% overall dissatisfaction and 1% regret. Reports showed 75% sexual activity, 13% dyspareunia, 87% sensation and 84% overall functional satisfaction. CONCLUSIONS: Multiple vaginoplasty techniques demonstrated safe and acceptable outcomes, with significant improvement of Quality of Life and self-image. However, standardized validation tools are needed for well-informed decision-making. Direct technique comparisons with similar cohorts and exploration of tissue-engineering methods are critical for future surgical advancements.