The vaginal route has gained significant attention as an effective alternative for local and systemic drug delivery, offering advantages such as avoidance of hepatic first-pass metabolism, enhanced bioavailability, and patient compliance. However, conventional dosage forms like creams and gels often suffer from poor retention and unpredictable drug release. To overcome these limitations, mucosadhesive vaginal tablets have emerged as a promising strategy, capable of adhering to the mucosal surface and providing sustained, localized drug delivery. This review highlights the anatomy and physiology of the vaginal tract, key factors affecting drug absorption, and the mechanistic principles of mucoadhesion. It discusses various formulation methods and polymers, natural and synthetic, such as chitosan, Carbopol, and cellulose derivatives, used to optimize adhesion, swelling, and release characteristics. Furthermore, it explores the therapeutic potential of mucoadhesive vaginal systems in hormonal therapy, contraception, infection control, and targeted cancer therapy. Thus, mucoadhesive vaginal tablets represent a novel and patient-centric approach to vaginal drug delivery, offering enhanced retention, controlled release, and improved therapeutic outcomes. Continued advancements in polymer science and formulation technology are expected to strengthen their clinical applicability and relevance in women’s health care.