Vulvar Vestibular Papillomatosis is a benign condition that can be regarded as the female equivalent of PPP in male genitals. Vestibular papillomatosis[rx] is a condition where a large number of papillae cover the entire surface of labia minora in a symmetric fashion. The dermoscopy of Pearly penile papules (PPP) appears white or pink in a cobblestone or grape-like pattern with each papule containing central dotted or comma-shaped vessels,[rx] whereas dermatoscopic features of genital warts morphologic features may vary from a fingerlike to the knoblike pattern, and the vascular pattern can be from glomerular to the dot.[rx] Unlike warts, however, PPP does not have desquamation, which is seen as an irregular reflection on dermoscopy.
Vestibular papillomatosis (VP) is a cutaneous condition of the vulva, characterized by pink, asymptomatic, fine projections of the vestibular epithelium or labia minora.[rx] It is the female equivalent to hirsuties coronae glandis.[rx][rx] It is often thought to be a human papillomavirus (HPV) infection, but several studies have shown that the condition is not viral and is not a sexually transmitted disease (STD).
Causes of Vulvar Vestibular Papillomatosis
Most doctors think this uncommon condition is a variation of the normal anatomy of the vulva, not an abnormality or disease.
It’s important to know that vestibular papillomatosis isn’t a sexually transmitted disease (STD). You can’t catch it from or pass it on to someone else.
There’s been a lot of debate about whether vestibular papillomatosis is caused by human papillomavirus (HPV), the virus associated with cervical cancer. But most now show that this isn’t true. A few doctors think you might have a higher risk of getting HPV if you have vestibular papillomatosis, but there isn’t any good evidence for this.
Vestibular papillomatosis isn’t caused by having sex or poor hygiene. However, keeping your vaginal area clean may help keep it from getting worse. If you use harsh soap or scrub the growths too hard, you may make it worse.
Symptoms of Vulvar Vestibular Papillomatosis
- Vestibular papillomatosis refers to small, painless, skin-colored bumps, or papules, that develop on the vulva.
- VP is asymptomatic in the majority of affected females; however, vulvar pruritus, pain or burning, and dyspareunia may accompany in some patients.[rx] Coexisting, VVS has also been reported – defined as severe pain on vestibular touch or vaginal entry, tenderness located within the vulvar vestibule.[rx]
- The feeling of irritation and burning can persist for hours or days following sexual activity, engendering a sense of hopelessness and depression in the patient.[rx]
- The papillae can be smooth, round bumps or finger-like projections. They’re 1-2 millimeters in diameter, slow-growing, and nontender.
DNA studies have shown that any relation to HPV is purely coincidental (as a high percentage of the sexually active population has or has had HPV).[rx] Vestibular papillomatosis is not transmittable or pathological. HPV will turn white upon a vinegar application test, and vestibular papillomatosis will not. Additionally, HPV occurs in cauliflower-like clusters at the base, whereas Vestibular papillomatosis does not. It cannot be sexually transmitted.[rx] Most women have no symptoms with the growth; however, some report itching, stinging, burning, and pain where the growths appear, and the symptoms are often misdiagnosed as a yeast infection. Like yeast infections, there is discharge associated with vestibular papillomatosis.[rx][rx][rx] The condition is sometimes referred to as squamous papillomatosis.
Diagnosis of Vulvar Vestibular Papillomatosis
Vestibular papillomatosis can be diagnosed clinically. This means your doctor can make the diagnosis by talking to you about the bumps and performing an examination. Your doctor must know what vestibular papillomatosis is to make the correct diagnosis, but many don’t.
Often vestibular papillomatosis is misdiagnosed as genital warts. A case report from 2010 describes the characteristics that can be used to tell the difference between vestibular papillomatosis and warts.
Papillae vs. warts
| Papillae: | Warts: |
| grow in a line and are symmetrical | spread around randomly |
| only occur on your labia minora or vulvar vestibule | can occur anywhere on the outer or inner vagina |
| are pink and shiny | can be a variety of colors and are dull |
| are soft when you touch them | are firm or hard |
| the base of each is separate from the others | the bases are all connected together |
| don’t change color when exposed to acetic acid | turn white when exposed to acetic acid |
When your doctor isn’t sure about the diagnosis, a biopsy, or a little piece of one of the papillae, can be removed. When this is looked at under a microscope, it has characteristic features that confirm that it’s vestibular papillomatosis.
Treatment of Vulvar Vestibular Papillomatosis
The papillae are benign and considered to be normal anatomy, so they don’t need to be treated. When you have vestibular papillomatosis, the main problem is that you may not be properly diagnosed. If your doctor misdiagnoses it as genital warts, you may undergo unnecessary tests and treatments. This can lead to unnecessary worry and expense.
If the bumps bother you a lot or interfere with sexual intercourse, your doctor can remove them with a simple procedure, but they sometimes just come back.
The most important things to remember if you’re diagnosed with vestibular papillomatosis are:
- It’s benign and isn’t and won’t turn into cancer.
- It isn’t an STD, so it can’t be picked up or passed on during sex.
A female with VP may be referred to a dermatologist for treatment of suspected genital warts. Therefore, it is imperative that dermatologists are familiar with this condition in order to avoid unnecessary treatment. However, there has been a scarcity of literature about this rare entity in the Indian dermatological scenario, highlighting an apparent disregard for this potentially misdiagnosed entity.
If you’re diagnosed with vestibular papillomatosis, your outlook is excellent. It’s not dangerous, usually has no symptoms, and requires no treatment. If for some reason you want to be treated, your doctor can perform a simple surgical procedure to remove the papillae.
References
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