Purpose of Review <p>Vaginal masses are rare in women but present a diagnostic challenge due to non-specific symptoms and similarities in patient presentation. The purpose of this article is to review symptom presentation, diagnostic work up and management of the most common vaginal masses found in women in the context of the recent literature.</p> Recent Findings <p>Vaginal masses can be broken down into 3 main categories: (1) embryological derivative (mullerian duct cyst or Gartner’s duct cysts) (2), ectopic tissue (epithelial inclusion cysts) and (3) urologic abnormality (urethral diverticulum). Despite the varied etiology, the presentation is often similar including vaginal mass, pain and voiding abnormalities. Recent studies have highlighted that the mainstay treatment for most vaginal masses is surgical excision. New techniques are being developed to better delineate masses and assist in meticulous dissection. Lastly, recent case reports highlight both the rarity and aggressiveness of vaginal wall malignancies. Timely diagnosis and management for these rare cases is important.</p> Summary <p>In summary, there is a broad differential diagnosis when assessing and treating vaginal masses. It is important to complete a thorough history and physical exam. When indicated, the preferred imaging modality is magnetic resonance imaging (MRI). Most vaginal masses are treated surgically and novel approaches to dissection and delineation are being published in recent literature. Malignancy is rare, but can require adjuvant chemotherapy and radiation therapy, so clinicians should be aware of this risk.</p>