The diagnosis of vaginal intraepithelial neoplasia (VAIN) has increased over the past several decades.  Overall, however, it remains a relatively rare condition.  As a result, our understanding of the natural history and best treatment options are incompletely understood and often stem from an extrapolation of our understanding of cervical and vulval preinvasive disease.  This presentation will review recent data on the natural history and malignant potential of VAIN as well as a discussion of treatment options available.