The increase finding of vaginal intraepithelial neoplasia (VaIN) in young women has led to the need to develop personalized conservative treatment. The authors studied the use of CO2 laser in the treatment of VaIN, evaluating the efficacy, repeatability, complications and the conservation of sexual function.A total of 37 consecutive patients with histologically demonstrated VaIN (10 VaIN 1, 14 VaIN 2 and 13 VaIN 3): mean age 45.3 years, 37.8% aged < 35 years, 20/37 in childbearing age; VaIN was isolated in two patients, synchronous in 22 and in 13 cases it was metachronous with other intraepithelial or invasive genital neoplasia. 30/37 patients were treated with laser surgery as outpatients for a total of 41 operations (37 vaporisations and four excisions) using colposcopic guided CO2 laser with a constant emission power of 35 watts or 30 watts in the pulsed mode, under local anaesthesia, following the application of 5% acetic acid.Twenty-one (87.5%) of the 24 patients evaluated at 12 months were negative after one (16 patients) or more treatments (from 2 to 5 in 5 patients). Following the second recidivation, one elderly patient preferred traditional demolitive surgery; 2 patients are still awaiting further laser surgery. Five patients with multifocal lesions associated topical treatment with 5-fluorouracil. None of the sexually active patients complained of dyspareunias after treatment.Given the lack of other equally effective treatment and with the aim of preserving genital integrity, the authors regard laser surgery as the elective treatment for VaIN 2 and 3.