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AIM High-grade vaginal intraepithelial neoplasia (VAIN) is considered to be a premalignant lesion. We conducted a 20-year retrospective observational single-center study on the effectiveness of vaginal stripping (local excision procedure) as a treatment for high-grade VAIN. METHODS Women diagnosed with VAIN and treated with vaginal stripping performed from 1998 to 2017 at our unit were identified using the hospital computer database. Vaginal stripping was performed for high-grade VAIN after being diagnosed by colposcopy-directed biopsies. The patients were followed every 3-6 months afterward via cytology monitoring and vaginal smear. Colposcopy-guided biopsy was repeated for high-grade abnormal cytology or persistent low-grade abnormality. The residual disease and recurrence rates were determined. Risk factors for margin positivity and residual and recurrent disease were identified. The association between margin positivity and recurrence was evaluated. RESULTS Excluding three women whose final histology were malignant, the follow-up smears and histology (if any) were traced in the remaining 111 women. The median follow-up time was 76 months. Twenty-one of them had persistent abnormal smears (14 high-grade lesions and seven low-grade lesions) during the year following the vaginal stripping. The residual disease rate was 18.9% (21/111). The recurrence rate was 7.2%. There were five women (4%) with procedure-related complications. History of hysterectomy was identified as a risk factor for recurrence. CONCLUSIONS Vaginal stripping is a valid treatment option for VAIN. High-grade VAIN post treatment recurred up to 5 years post treatment. Regular long-term surveillance is needed.