OBJECTIVE: To determine whether cytological smears of the vulva correlate with vulvar biopsies of vulvar intraepithelial neoplasias (VINs). MATERIALS AND METHODS: A retrospective chart review (1995-2000) was performed to identify cases of VIN and vulvar carcinoma and to correlate vulvar Pap smears with biopsy results. RESULTS: Four hundred vulvar Pap smears were identified. Fifty of these patients had concomitant vulvar biopsies, and these cases constitute our study group. Twenty-two of these 50 women had biopsy-proven VIN or vulvar carcinoma. Only 7 (32%) of 22 patients with biopsy-proven disease had a vulvar Pap smear significant for VIN or vulvar carcinoma. The kappa statistic was 0.30 (95% CI=0.08-0.52), indicating poor agreement between vulvar cytology and biopsy results. CONCLUSIONS: Vulvar cytological evaluation did not correlate well with tissue diagnosis of VIN; and thus, our findings do not support the use of vulvar cytology in the clinical management of VIN.