A retrospective analysis of 29 cases of squamous cell neoplasia of the vagina following hysterectomy is presented. Two groups of patients were identified; the first presented following hysterectomy for cervical dysplasia or neoplasia on an average of 5.7 years later, and the second presented following hysterectomy for benign or unrelated disease 13.1 years after initial surgery. All 17 patients in the first group had Stage I disease whereas two thirds of the second group had Stage II or greater disease at the time of diagnosis. Surgery was the primary mode of therapy in 82.4% of the first group and radiotherapy was used in 83.3% of the second group. In all patients 20.7% had received previous radiotherapy to the pelvis. Carcinoma of the vagina following hysterectomy for benign disease tends to be more advanced at the time of diagnosis and subsequently has a poorer ultimate prognosis. Disease following previous cervical neoplasia is often asymptomatic and only detected on routine cytologic testing.