Aim of the Study: To evaluate the presentation features of intraepithelial vaginal neoplasia, the clinical outcome in LaserCO₂ vaporization treated patients, the therapeutic results, the procedure-associated complications, and the risk factors for recurrence. Materials and Methods: This was a retrospective study of 587 consecutive patients diagnosed with vaginal intraepithelial neoplasia (VAIN) and treated by laserCO₂ vaporization at Spedali Civili of Brescia between January 1990 and June 2018. All the patients underwent cytological and colposcopic follow-up. Recurrences were evaluated in terms of clinical features and association with risk factors. Chi-Square was used to establish the correlation between the two groups. Results: Mean age was 40.9 years. Most lesions were localized at the vaginal superior third (94.4%), 55.3% were multifocal, and 49.5% were associated with synchronous intraepithelial cervical neoplasia (CIN). In 8% of cases, VAIN affected the vaginal vault in hysterectomized patients. In 84,4% among the 282 evaluable cases, a vaginal swab was positive for HPV. HR-HPV was more frequent in high-grade lesions. No intraoperative complications were registered and the treatment was well tolerated. Follow-up was available for 428 patients with a mean duration of 56 months. Complete regression of VAIN after treatment was 85.3% with a recurrence rate of 14.7%. HR-HPV has been identified as a significant risk factor for recurrence. Conclusions: LaserCO₂ vaporization is a safe, low impact, and effective technique for VAIN therapy with a high success rate. HR-HPV must be considered an independent risk factor for recurrence.