VaIN (Vaginal Intraepithelial Neoplasia) is a challenge disease for gynecologists: it is often undiagnosed, difficult to treat, with high rate of recurrence and, in some cases, it can progress to invasive vaginal cancer. Multiple treatments are often required, with a potential impairment of women’s quality of life. To get a proper diagnosis and adequate treatment, all the women with abnormal pap smear, should undergo an accurate colposcopic evaluation of vaginal walls. A colposcopy-guided biopsy of suspicious lesions is mandatory. The treatment of VaIN (especially the most complex cases) should be performed by expert colposcopists in referral centres.