Pre-malignant conditions affecting the vulva are rare, although the incidence of vulval intra-epithelial neoplasia has been increasing over the last 20 years. Despite their rarity, these conditions require timely diagnosis and individualized, often multidisciplinary, management. The conditions covered in this article are vulval intra-epithelial neoplasia, lichen sclerosus and Paget's disease. The aetiology, diagnosis and current management for each of these conditions will be described.