This study compares the outcome of Singapore flap, vertical rectus abdominis musculocutaneous flap (VRAM), and gracilis musculocutaneous flap vaginal reconstruction. A retrospective review of 99 consecutive patients with complete vaginal defects was conducted from January 1988 to October 2001. All possible complications were determined for each of the three reconstructive techniques. Preoperative and postoperative sexual function and adequacy were compared between each group. The mean follow up was 28.9 months. Forty-one VRAM, 13 Gracilis, and 45 modified Singapore flaps were used for vaginal reconstruction. The overall complication rate was lower following VRAM than either gracilis or Singapore flap reconstructions (13/41 31.7%, 8/13 61.5%, 21/45 46.7% respectively). The flap specific complication rate was least in the VRAM group (9/41 22%, 7/13 53.8%, 17/45 37.8% respectively). The VRAM had a significant protective effect against the development of postoperative small bowel obstruction. Preoperative sexual activity predicted postoperative activity in 75 of 88 patients (85.2%) and was not affected by the type of reconstruction. In conclusion, the VRAM has a lower overall and flap-related complication rate compared to either gracilis or Singapore flap reconstruction. It has become our vaginal reconstructive flap of choice.