A healthy 25-year-old white woman presented with a 2-year history of vaginal pruritus, burning, and dyspareunia. Numerous grayish purple macular and papular lesions, ranging in size from 0.5 to 2.0 mm, were observed on both labia majora. Some were centrally eroded. Biopsy confirmed the diagnosis of angiokeratoma. All lesions were electrocauterized, with the patient under local anesthesia. No new lesions appeared during a 6-month follow-up period, and the patient remained asymptomatic. Vulval angiokeratomas probably occur more commonly than the literature suggests. Occasionally they may be confused with other lesions. Since they are easily treatable, clinicians should be alert for their presence when diagnosing pruritic, painful, or bleeding lesions of the vulvovaginal region.