Cervical intraepithelial neoplasia is an increasingly common finding among sexually active young women. Many of these women have not completed their families, so preservation of fertility is an important factor to consider when planning appropriate treatment. In the past, management of precancerous cervical lesions was aggressive, primarily consisting of conization of the cervix. This procedure yielded excellent cure rates but was associated with a high incidence of complications. The widely accepted use of colposcopy in the evaluation of abnormal cervical cytology and the use of ablative and conservative excisional treatment modalities have resulted in a decreased number of conization procedures. More recently, management of cervical intraepithelial neoplasia has taken a more conservative approach. This article describes the risks and benefits of the multiple modalities available for the management of cervical intraepithelial neoplasia.