Four patients with primary vaginal invasive squamous cell carcinoma are reported. They accounted for 0.3% of all females with genital tract malignancies diagnosed in the south of Israel between 1961 and 1996. One patient had Stage I disease, one--Stage II, one--Stage III and one--Stage IV. One patient was treated with external radiotherapy followed by intracavitary brachytherapy, one patient was treated with external radiotherapy followed by interstitial brachytherapy, one patient had systemic chemotherapy and one patient had no treatment. At the time of writing, one patient was alive without disease, one was alive with progressive disease, one had died of disease and one had died of intercurrent disease. It is concluded that primary vaginal carcinoma is a very rare entity with an estimated incidence of about 0.1-0.2/100,000 women. Most patients present with tumor extending beyond the vaginal wall (Stage II, III and IV) and the mainstay of treatment for these patients is radiotherapy. The overall 5-year survival rate is about 50%.