There has been a rapid expansion in the use of payments for environmental services (PES) as a key conservation finance policy. However, there is insufficient understanding of how gender can affect PES implementation and outcomes. We present results from a case study in Viet Nam, where a national PES programme has been in place for a decade. Through panel household survey data, focus groups and interviews, we examined how women have been involved in PES policies, what the impacts have been on decision-making by men and women, participation rates and use of PES income over time, and the potential conservation outcomes. Our research confirms that resource use varies between men and women, and changes in access rights can fall disproportionately on women. Participation in PES has been lower for female-headed households and for women within male-headed households, although gradually more equitable participation has evolved within households. Female-headed households reported expending more yearly effort on PES activities despite protecting less land, and also increased their conservation activities over time as they presumably became more familiar with PES. Use of income from PES also showed differences between male and female-led households, with men more likely to spend funds on non-essential goods. Within households, although men initially decided how to spend PES money, decision-making has become more equitable over time. We conclude with some recommendations on how to increase attention to gender in PES projects and future research to improve outcomes.