The confocal microscopy is an optical imaging technique that allows true optical biopsies and a three-dimensional visualization of tissue sections and cells. The analysis of the signal is done thanks to reflected light (reflectance confocal microscopy) or to the fluorescence emitted by tissues (fluorescence confocal microscopy). The use of confocal microscopy in the gynecological field is still experimental and is mainly about the ex vivo and in vivo diagnosis of cervical dysplasia and ovary cancer. The miniaturization of the probes could allow an endoscopic use for the diagnosis of endometrial or ovary cancers. We aim to present the principles of confocal microscopy and to expose the main ways of research and the future and potential clinical applications of this technique in gynecology.