To evaluate the clinical efficacy of high-intensity focused ultrasound (HIFU) in treating low-grade intraepithelial neoplasia (VaIN-1) in the vagina. Between June 2020 and December 2024, 135 patients with pathologically confirmed VaIN-1 were initially enrolled. After excluding 8 cases lost to follow-up, 127 patients were assigned to the HIFU group ( In the HIFU group, twenty-six patients (37.7%) were cured, 36 patients (50.7%) were effectively treated, and 8 patients (11.6%) were ineffectively treated, resulting in an efficacy rate of 88.4%. In the interferon group, three patients (7.0%) were cured, 8 patients (18.6%) were effectively treated, 31 patients (72.1%) were ineffectively treated, and 1 patient (2.3%) experienced worsening of the disease, resulting in an efficacy rate of 25.6%. In the nonintervention group, 3 patients (20.0%) recovered, 10 patients (66.7%) experienced no change, and 2 patients (13.3%) experienced worsening of the disease, resulting in a clinical self-healing rate of 20.0%. The total efficacy rate was significantly greater in the HIFU group (88.4%) than in the interferon group (25.6%) and the nonintervention group (20.0%) ( This study suggests that HIFU is a safe, minimally invasive, and potentially effective approach for VaIN-1. These findings should be confirmed by larger, long-term randomized controlled trials before the treatment is adopted into routine practice.