The foundation of vaginal health is dependent on the homeostasis of vaginal microflora. Acute and chronic vaginitis will be discussed, from the simple and common to the elusive in their etiology, and/or difficult, complex, recurring and those resistant to common treatments. This lecture will include diagnostic issues in vaginitis, advanced skills in understanding vaginal ecology, practical yet advanced skills in diagnosis, and advanced skills in successfully treating chronic and/or difficult cases of vaginitis infections.