Vaginal Intraepithelial Neoplasia (VaIN) is a rare preinvasive disease that accounts for up to 1% of women who attend the colposcopy clinic. In this chapter we will review the characteristics of the disease (i.e., location in the vagina, single versus multifocal presentation), the risk factors for VaIN (i.e., other invasive or pre-invasive disease of the low genital tract, smoking), methods of screening for the diagnosis (including vaginal cytology, oncHPV testing), and role of colposcopy in making the diagnosis. Strategies for enhancing the colposcopic identification of VaIN will be discussed such as the use of vaginal estrogen, use of 3-5% acetic acid and Lugol’s solution. Treatment strategies, indications for specific maneuvers and the likelihood of success and complications will be presented for 5FU (Effudex®), CO2 laser ablation/excision, upper vaginectomy, colpectomy, vaginal brachytherapy, and Aldara®. Recommendations for follow-up will be provided.