What is Vestibular Papillomatosis and How Do I Treat It?
Dr. Angel Rivera
Vestibular papillomatosis is a condition that occurs in women on their vulva, which are the external parts of female genitalia.
These tiny bumps can be cause for concern if you have never noticed them before as they can often be mistaken for other medical conditions that are not as benign.
It can be noted, however, that vestibular papillomatosis is not cancerous and is not contagious, and it is not a reason for concern.
In this article, we will answer questions you have about vestibular papillomatosis, from its symptoms to any treatment options that may be available to you.
What is vestibular papillomatosis?
Vulvar vestibular papillomatosis, sometimes called vulvar squamous papillomatosis or just vestibular papillomatosis, is a benign condition that results in the growth of papillae which are papules or small growths on the vulva.
These small bumps, about one to two millimeters, are shiny, skin-colored or pinkish projections and usually occur in linear clusters, so in a straight line, or in symmetrical patches.
The areas that are affected by it include the vulva vestibule, also called the vestibular epithelium, which is the area outside the vaginal opening to the labia minora, or the labia minora, also called the vaginal lips or inner labia, which are the flaps of skin on both sides of the vaginal opening.
All women of any ethnicity can have vestibular papillomatosis and it is thought to affect anywhere from 1% to 33% of women although more data is needed. It is thought to be the female equivalent of hirsuties coronae glandis, which is a condition that occurs in men where pearly penile papules appear on the penis.
How do you get vestibular papillomatosis?
Vestibular papillomatosis is a normal anatomical variant of your vulva. Having sex or poor vaginal hygiene are not causes of vestibular papillomatosis.
Vestibular papillomatosis is not contagious and cannot be passed from person to person so it is not a sexually transmitted disease (STD).
It was believed that the condition was caused by a viral infection called the human papillomavirus (HPV) although this has been proven to be false and any occurrence of both conditions is purely coincidental.
Due to their benign nature, you may not even know you have them. There are some instances that have shown vestibular papillomatosis is congenital, meaning a birth defect, although it is very rare.
What are the symptoms of vestibular papillomatosis?
The main symptom of vestibular papillomatosis is the presence of small, wart-like bumps on the vulva.
The bumps are soft, typically skin-colored although sometimes they can appear clear and are one to two millimeters in size.
They are not painful and are usually only noticed by your doctor when you have other unrelated conditions or a physical.
If you notice any pain, redness, itching, or chronic irritation it is most likely due to having vulvar vestibulitis, and not due to vestibular papillomatosis.
What causes vestibular papillomatosis?
The cause of vestibular papillomatosis is unknown. It was once thought to be caused by HPV but that has been debunked and it is now known that the two conditions are not related.
Vestibular papillomatosis is a benign condition and is not cancerous or contagious. It may develop in response to changes in the vulvar environment including local trauma, inflammation, or irritation although this has not been proven.
Irritating the bumps by scrubbing the area or using a strong soap may actually make the condition worse.
It is unknown due to a lack of study if there is a genetic factor that is inherited from your parents that can cause these bumps.
How do doctors diagnose vestibular papillomatosis?
A clinical diagnosis of vulvar vestibular papillomatosis is usually made during a physical or pelvic exam although they are so small they may not be visible to the naked eye.
Your doctor will take a swab of the area to check for HPV which as we now know, is not related to vestibular papillomatosis.
Your doctor may also do a biopsy which is taking a small sample of tissue to be sent off to the lab for further testing as many doctors misdiagnose this condition as genital warts due to lacking information about vestibular papillomatosis.
Analyzing the tissue sample under a microscope will confirm to your doctor that it is vestibular papillomatosis and not any other condition.
How do you treat vestibular papillomatosis?
There is no vestibular papillomatosis cure and treatment is usually unnecessary as it is considered a normal variation of your anatomy and they are benign, asymptomatic papules.
If you feel self-conscious about your vestibular papillomatosis or if they interfere with sexual intercourse, your doctor can remove them by surgical excision although they may grow back.
If your doctor believes you have genital warts, they may carry out other treatment options which will not affect your vestibular papillomatosis but can cause concern while wasting your time with unnecessary treatment and doctor's visits.
What other conditions are mistaken for vestibular papillomatosis?
As noted above, vestibular papillomatosis is often mistaken for certain genital disorders, specifically genital warts. Genital warts are growths on the skin caused by the human papillomavirus virus (HPV) and are contagious.
They can be treated with over-the-counter medication, home remedies, or prescription medication from your doctor.
The way to tell the difference between vestibular papillomatosis and genital warts is that vestibular papillomatosis occurs in the typical pattern of a line, are soft, pink, shiny, and only occurs on your vulva and labia minora and none of the adjacent skin.
Each individual projection is also an individual papillary projection separate from the others at the base and does not turn white when exposed to the vinegar application test, also called the acetic acid application test, which is a common test of putting vinegar (acetic acid) on a cotton swab and rubbing it on the bumps.
If you have genital warts, the warts are firm, occur randomly anywhere on the inner or outer vagina, are not shiny, and occur in a variety of colors.
They also are connected at the base and will turn white within a minute when exposed to the vinegar application test.
The human papillomavirus virus can also cause genital warts and they can be sexually transmitted whereas vestibular papillomatosis has no relation to HPV and is not contagious at all. Genital warts can also be itchy and you may experience a discharge which is not the case for vestibular papillomatosis.
If your doctor is uncertain, they may provide a provisional diagnosis of either genital warts or vestibular papillomatosis until they see the results of a biopsy sample or use the vinegar application test for the correct diagnosis.
Vestibular papillomatosis is a condition that is characterized by shiny, skin-colored, papules on your vulva.
The condition occurs naturally and is not contagious and can not be transmitted through sexual intercourse. It is thought to be a normal variation of the vagina and the causes are unknown.
The papules typically occur in a linear fashion and are one to two millimeters in size often with no discernible symptoms.
Your doctor can diagnose them through a physical exam or biopsy and no treatment is necessary unless you do not like them or if they affect sexual activity.
If you have any more questions regarding vestibular papillomatosis or are wondering if you have genital warts, please consult with your doctor or healthcare provider for a differential diagnosis.
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