Woman experiencing genital discomfort wondering about symptoms of vestibular papillomatosis vs. HPV

Vestibular Papillomatosis vs. HPV: What to Know

Written on October 31, 2023 by Amy Harris, MPH, RN. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.

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Do you have some bumps in your nether regions that are worrying you? You are not alone. (HPV), which causes gentle warts, is the most common STD.[1] You can ease your worries aside by learning more about what symptoms STIs can cause and maybe even scheduling an online STD consult with Everlywell. But, if you have a vulva, those worrisome bumps may not be HPV. They could be something perfectly normal called vestibular papillomatosis. Read on for a comparison of vestibular papillomatosis vs HPV.

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What Is Vestibular Papillomatosis?

Vestibular papillomatosis skin condition of the vulva (outside lips of the vagina), vestibule, and labia. This skin condition is not dangerous and is not painful. Vestibular papillomatosis does not need treatment. It is a normal variation of the skin of your vulva, not something to treat or remove. Researchers estimate that somewhere between one out of every 100 people and one out of every 30 people with a vulva will have vestibular papillomatosis.[2]

How Does Vestibular Papillomatosis Look Different From Genital Warts?

Many people, when noticing any new bumps on their genitals, wonder whether they have herpes or HPV. If you have a vulva, you might want to add vestibular papillomatosis to the list of possible causes, especially if your bumps are not painful.

Vestibular papillomatosis usually appears as clusters of small, shiny, skin-colored growths or bumps along the inner folds of your vulva.[3] They may be present in a line or cluster together symmetrically on either side of your labia. The bumps called vestibular papillomatosis can grow slowly but usually don’t grow larger than the tip of a crayon (1-2 millimeters).

Genital warts can look very different in different people and on different parts of the genitals. That is why it can be helpful to have any suspicious bumps checked out by a healthcare professional or to describe your symptoms to a sexual health expert, as you can do with Everlywell’s online STD consult service.

Genital warts can be raised or flat and sometimes have a rough or whitish appearance that resembles cauliflower.[1] They are not symmetrical, like vestibular papillomatosis (mirror image of each other on either side of your labia). Genital warts are firmer than vestibular papillomas and join together at their base, whereas vestibular papillomas do not.[4]

Genital warts can grow on any moist tissues in the genital area—penile skin, scrotum, labia, vulvar vestibule (the part of vulva between the labia majora), walls of the vagina, cervix, in the area between the vagina and the anus, around the anus, and anal canal.[5]

Is Vestibular Papillomatosis An STI?

No. Research shows that HPV does not cause vestibular papillomatosis.[6] Vestibular papillomatosis has not been seen in partners of those with vestibular papillomatosis, so it is not believed to be sexually transmitted.

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How Is Vestibular Papillomatosis Different From HPV?

Several key differences are helpful to know about HPV and vestibular papillomatosis [1,4]:

  1. HPV can be sexually transmitted, but vestibular papillomatosis can’t.
  2. HPV infects both men and women. Vestibular papillomatosis is only found on vulvas.
  3. There is a vaccine to prevent HPV infection.
  4. HPV can have complications. Vestibular papillomatosis does not.
  5. There are at-home HPV tests for women to screen for some types of HPV in people with a vagina but no tests for vestibular papillomatosis.
  6. Vestibular papillomatosis does not go away. People with healthy immune systems can generally clear the HPV virus within two years, and one out of every three genital warts will go away on their own.

Are There Tests To Know Whether I Have Vestibular Papillomatosis Or HPV?

Not really. The best “test” is a visual exam done by a licensed medical provider with lots of experience looking at vulvas and genital warts. Some clinicians may apply white vinegar to your bumps to see whether or not they turn white. This screen is called the aceto-white test.[7] The areas affected by vestibular papillomatosis will not turn white.

Healthcare providers may look closely at your vulva (hello, up close and personal!) with something called a dermascope. A dermascope is a small, handheld device that lights up and magnifies your skin so that your healthcare provider can better tell whether you have HPV lesions or something else.

If your healthcare provider isn’t sure, they may choose to do a biopsy. They would remove a tiny piece of the skin bump for a biopsy and look at it under a microscope. In some cases, they may be able to test this sample for HPV DNA. The tiny skin cells in the vestibular papilloma will look uniquely different from normal vulvar skin cells or even skin cells infected with the HPV virus—helping you and your provider be more confident that you have vestibular papillomatosis, not HPV. That said, those people assigned female at birth (AFAB) can have both vestibular papillomatosis and genital warts.[4]

Choose a Healthier, More-informed Sex Life with Everlywell

Everlywell wants to put you in the driver’s seat regarding your sexual health. Learning more about the various skin conditions that can affect the genitals helps you stay “in the know.”

You can ease your STI anxiety by regularly getting tested for the most common STIs or those that you are most at risk for. Everlywell offers convenient at-home STD testing to make your life so much easier.

If you have questions about which STIs to test for, you can schedule a virtual STD consultation with one of Everlywell’s expert sexual healthcare providers in two hours or less on the same day. If you are specifically curious whether you have one of the higher-risk strains of HPV known to cause cancer, those assigned female at birth can take Everlywell’s at-home HPV test.

So, if you or your partner just noticed some bumps on or around your genitals, don’t drive yourself crazy wondering if an STI caused them. Sexually transmitted infections are much more common than vestibular papillomatosis, so while the odds might not be in your favor, you might be worrying unnecessarily about your bumps.

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HPV Symptoms: What Are the Symptoms of HPV in Females?

References

  1. Quinlan J. Human Papillomavirus: Screening, Testing, and Prevention. Am Fam Physician. 2021;104(2):152-159. https://www.aafp.org/pubs/afp/issues/2021/0800/p152.html.
  2. Welch J, Nayagam M, Parry G, et al. What is vestibular papillomatosis? A study of its prevalence, aetiology and natural history. Br J Obstet Gynaecol. 1993;100:939-42.8217979. PMID: 8217979.
  3. Ozkur E, Falay T, Turgut Erdemir AV, Gurel MS, Leblebici C. Vestibular papillomatosis: An important differential diagnosis of vulvar papillomas. Dermatol Online J. 2016;22(3):13030/qt7933q377.
  4. Sally R, Shaw K, Pomeranz M. Benign “lumps and bumps” of the vulva: A review. International Journal of Women's Dermatology. 2021;7(4):p 383-390. DOI:10.1016/j.ijwd.2021.04.007
  5. Genital warts. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/genital-warts/symptoms-causes/syc-20355234. Published June 30, 2023. Accessed October 15, 2023.
  6. Pao CC, Hor JJ, Fu YL. Genital human papillomavirus infections in young women with vulvar and vestibular papillomatosis. Eur J Clin Microbiol Infect Dis. 1994;13(5):433-436. doi:10.1007/BF01972005.
  7. Kumar B, Gupta S. The acetowhite test in genital human papillomavirus infection in men: what does it add?. J Eur Acad Dermatol Venereol. 2001;15(1):27-29. doi:10.1046/j.1468-3083.2001.00196.x
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