Objective: To report a rare case of urethrovaginal communication and vaginal atresia. Design: To reconstruct the communication and the vaginal route. Setting: Division of Pediatric and Adolescent Gynecology and Corrective Gynecological Surgery, University of Athens, and “Alexandra” Hospital. Patient(s): A 16-year-old girl with cyclic hematuria, periodic pelvic pain, and primary amenorrhea. Intervention(s): Diagnostic studies, followed by an abdominoperineal-vaginal pull-through procedure. Main Outcome Measure(s): Reconstruction of the urethrovaginal fistula and vaginal route. Result(s): Normal menstruation through the vaginal route. Conclusion(s): A careful examination of every infant's external genitalia should be performed immediately after delivery. A urethrovaginal fistula should be corrected in time to facilitate menstrual flow and improve future reproductive potential.