Vaginal infections are very common, especially in women of reproductive age. Although not associated with high mortality, these infections are associated with significant distress and reduced quality of life. In most cases, topical treatments for vaginal infections have been shown to be as effective as oral treatments, resulting in increased topical drug concentrations and fewer drug interactions and side effects. In addition, the development of microbial resistance to chemotherapy drugs and the difficulty in treating recurrent infections support the need for more effective topical therapies. However, traditional dosage forms cause vaginal contractions and discomfort. Development strategies such as the development of bioadhesives, thermogel systems, microtechnological or nanotechnological approaches have been proposed to improve the availability of conventional drugs, and other therapeutic approaches such as new drugs, plant extracts, and probiotics are being investigated. This article reviews recent strategies to improve the treatment and prevention of the most common vaginal infections, including vaginal bacteriosis, aerobic vaginitis, vaginal candidiasis, and trichomoniasis.