Vestibular papillomatosis is a harmless, anatomical variation of the vulva that can be described as a benign, painless, skin-colored papule that measures about 1-2mm. These bumps are non-communicable, not caused by HPV or poor hygiene, and are not problematic unless the patient wishes to have them removed due to cosmetic concerns.
Finding bumps on your genitals can be a very anxiety producing experience. Some women even assume that they are symptomatic of an STI. However, genital growths do not always mean that there is a medical concern.
Vestibular papillomatosis is a benign condition, that frequently creates unnecessary fear and anxiety. These bumps are easily confused by even some medical professionals as genital warts. The goal of this guide is to provide you with reliable and fact-based information on vestibular papillomatosis, how medical professionals differentiate them from viral infections, and what to do when you see these symptoms. With this guide, you will have the tools to discuss your reproductive health to the medical professionals with confidence.
What is Vestibular Papillomatosis?
Vestibular papillomatosis is the term used for the small, benign, growths that are smooth and skin colored and located on the vulva. The medical community has classified vestibular papillomatosis as a normal anatomical variation of the female anatomy and is often described as the female version of pearly penile papules.
These growths, which are also called papillae, are typically found in an asymmetrical pattern and are located almost exclusively on the labia minora and the vestibule of the vulva.
Research by Wollina and Verma from 2010 suggests that 1%-33% of adult women experience vestibular papillomatosis. This condition shows no racial or ethnic preferences. Since the bumps are not painful, women tend to live with vestibular papillomatosis without a diagnosis.
Why does Vestibular Papillomatosis develop?
Currently there is no known cause for the development of vestibular papillomatosis, however, doctors believe it to be a congenital, non-pathologic, non-communicable condition.
For a long time, the presence of these bumps on the vulva lead to the misconception of a given case of vestibular papillomatosis as an HPV infection. This theory has been disproven by new techniques of analysis in molecular biology. A study conducted by Moyal-Barraco et al., in 1990, established that there are no HPV infections in the lesions of vestibular papillomatosis. This study was followed by another study by Origoni et al., in 1999, which confirmed the absence of infections in vestibular papillomatosis.
There is also no relationship between vestibular papillomatosis and poor hygiene. It is not possible to eliminate the papillae by aggressive soap cleansing.
What are the signs and symptoms of Vestibular Papillomatosis?
The majority of patients suffering from vestibular papillomatosis show no signs and symptoms. The condition tends to be painless with no alteration to the normal vaginal discharge.
The sign of papillae when observing vulvas has unique characteristics. Bumps are about one to two millimeters. They are smooth, shiny, and pink. They can appear as small domes or have elongated and finger-like projections.
An example of a characteristic of vestibular papillomatosis is that bumps are separated. They are soft and slow growing. If a patient is experiencing intense pain, a burning or redness in the vaginal opening, it is most likely caused by a separate condition, vulvar vestibulitis, and not caused by vestibular papillomatosis.
How is Vestibular Papillomatosis diagnosed by Healthcare Providers?
An experienced physician will evaluate vestibular papillomatosis through a common visual clinical examination, and diagnosis will not likely be an issue. The greatest hurdle to diagnosis will be differentiating vestibular papillomatosis from genital warts.
According to a clinical report by Khan et al. [2023], tendencies of some practitioners to be inexperienced have led to improper diagnosis relatively often. Patients that are diagnosed with vestibular papillomatosis, and are therefore confused and distressed, have been subjected to unnecessary and ridiculous medical interventions.
To be diagnosed with vestibular papillomatosis, there must be the following clinical traits that set it apart from other genital lesions. If your stated symptoms are consistent with those of vestibular papillomatosis, please demand an alternate medical diagnosis when your doctor states you have genital warts.
- Base Structure: Papillae in vestibular papillomatosis have separate bases. Bases of genital warts are fused.
- Distribution: Papillae in vestibular papillomatosis are distributed in a symmetric and uniform order. Genital warts are distributed in an asymmetrical and haphazard order.
- Texture: Papillae in vestibular papillomatosis are soft. Genital warts are firm, hard, and rough.
- Color reaction: When genital warts are treated with a 5% acetic acid solution, they appear white. Vestibular papillomatosis does not change color and remains pink.
If the visual exam does not provide a definitive diagnosis, your doctor will probably perform a simple skin biopsy. The sample will be sent to pathology. The diagnosis of vestibular papillomatosis will be confirmed if koilocytic change is not seen.
What treatments are available for Vestibular Papillomatosis?
Because vestibular papillomatosis is a benign variation, treatment is not indicated. The presence of papillae will not progress to cervical cancer and are not detrimental to your health.
In the majority of cases, management consists of educating and providing reassurance to the patient. Most women do not need further healthcare when they learn that vestibular papillomatosis is not a disease and does not pose any health concerns or risk to others.
In a few cases, treatment is performed due to concerns that are mostly cosmetic, or the treatment is performed to reduce the physical contact that the papillae create during sexual intercourse. If treatment is still desired, gynecologists and dermatologists have the ability to remove the papillae.
Surgical removal is indicated when the papillae significantly affect sexual intercourse due to the presence of the papillae, or when the presence of the papillae affects your mental wellbeing. Removal may be performed using any of the following techniques:
- Cryotherapy (freezing the papillae with liquid nitrogen),
- Electrocautery (cauterization of the papillae),
- Laser therapy (vaporizing the papillae with a laser), or
- surgical excision (cutting the papillae under a local anesthetic).
It’s necessary to keep in mind that, since bumps from vestibular papillomatosis are part of the anatomy, the bumps will likely grow again after removal.
What are the mental health impacts of vestibular papillomatosis?
The mental health effects are the most concerning issues with vestibular papillomatosis. The biggest one is a misdiagnosis. The mental strain of being told that you have a communicable, contagious, and possibly threatening to your health, sexually transmitted infection is monumental. It causes anxiety, shame, and stress to yourself and your loved ones.
From a psychological standpoint, there is a positive aspect to receiving the correct diagnosis of vestibular papillomatosis. In fact, there is a huge sense of relief. It is important to provide the correct health information. This allows woman to accept and be comfortable with their bodies and not be in fear of having a potentially fatal disease. The best way to reduce health-related anxiety is through open and honest communication with your health care provider.
Taking control of your reproductive health
Finding bumps on the vulva can be a source of great anxiety; however, knowing that vestibular papillomatosis is benign can be a great source of relief. Papillae are a normal variant of the human anatomy and are not a communicable disease. They are small, symmetrical, and painless.
If there are changes to your genitalia, you should see your gynecologist or a dermatologist. You should demand a complete evaluation and ask that vestibular papillomatosis be ruled out before any aggressive interventions be performed for genital warts.
Frequently Asked Questions
What is the cost of Vestibular Papillomatosis treatment?
Medical treatment is not necessary for health reasons for vestibular papillomatosis, so insurance companies generally classify removal procedures as cosmetic. The cost for removal is typically $200 – $800 and depends on the method and location as the procedures are elective. The most common methods are cryotherapy and laser therapy.
What is the lifespan of Vestibular Papillomatosis?
Vestibular papillomatosis is a lifelong condition. Although the papillae are slow-growing, they tend to remain unchanged throughout adulthood, and will not shrink on their own.
What happens if Vestibular Papillomatosis is not treated?
Leaving vestibular papillomatosis untreated is not linked to any medical condition. There is no increased risk of developing cancer, nor is there an increased risk of other infections. It also will not impact overall physical health or fertility.
Who is most likely to be affected by Vestibular Papillomatosis?
Vestibular papillomatosis is a congenital variation and a predisposition to develop this condition is present from birth. It manifests in adult women, regardless of their racial or ethnic background. It is estimated to affect 1% to 33% of the global population of women.
What non-surgical options are available?
The most recommended non-surgical option is watchful waiting with reassurance. Other methods remain unimpactful while carrying health risks. Since topical creams for warts cause chemical burns to the healthy tissue, observation is the most effective and safe strategy for management.
