To evaluate the efficacy of photodynamic therapy (PDT) for vaginal intraepithelial neoplasia grade 1 (VaIN1) related to high-risk (Hr)-human papillomavirus (HPV). Participants aged 25-65 years treated for VaIN1 between March 2022 and September 2022 were retrospectively analyzed into three groups. The PDT and follow-up groups were matched 1:1 for gravidity, HPV type, and quadrants involved. The PDT and CO After matched, the lesion and Hr-HPV clearance rates of the PDT group (89.5%, 89.5%, 92.1%, and 81.6%, 84.2%, 89.5%) were significantly higher than those of the follow-up group (31.6%, 50.0%, 63.2%, and 21.1%, 26.3%, 31.6%, P < 0.05) at 6, 12, and 24 months. But the lesion clearance rates did not differ significantly between the PDT (68.9%, 82.2%, and 91.1%) and CO Compared with CO