女性下生殖道癌前病变主要包括子宫颈、阴道、外阴上皮内的高级别病变，其进展与子宫颈癌、阴道癌、外阴癌的发生密切相关。阴道镜检查作为一种内镜检查技术，通过光学放大与特殊染色，可清晰观察下生殖道上皮及血管的细微形态变化，从而引导医师对可疑病变进行活检，并做出病理诊断。阴道镜检查在下生殖道癌前病变的筛查分流、精准诊断、治疗指导及术后随访中发挥着不可替代的核心作用。文章将系统阐述阴道镜在女性下生殖道癌前病变全程管理中的作用，结合其在子宫颈疾病管理中的核心地位，梳理其在不同部位癌前病变及特殊人群中的应用要点，旨在为临床规范化诊疗提供理论依据与实践指导，以降低下生殖道恶性肿瘤的发生率与死亡率。

Precancerous lesions of the female lower genital tract are predominantly high-grade intraepithelial lesions of the cervix，vagina and vulva，whose progression is closely linked to the development of cervical，vaginal and vulvar cancers. As an endoscopic examination technique，colposcopy adopts optical magnification and special staining to clearly identify subtle morphological changes in the epithelium and blood vessels of the lower genital tract，guiding clinicians to perform targeted biopsy of suspicious lesions and make pathological diagnosis. It plays an irreplaceable core role in screening triage，precise diagnosis，therapeutic guidance and postoperative follow-up of such precancerous lesions. This article systematically illustrates the role of colposcopy in the whole-process management of precancerous lesions of female lower genital tract， and considering its core role in cervical disease management，the article summarizes the key application specifications for precancerous lesions at different anatomical sites and in special populations. This study aims to provide theoretical basis and practical guidance for standardized clinical diagnosis and treatment，so as to reduce the incidence and mortality of malignant tumors of the lower genital tract.