What is vestibular papillomatosis? A study of its prevalence, aetiology and natural history

Abstract

Objectives To clarify the prevalence, aetiology, symptoms and natural history of vestibular papillomatosis. Design Study in two parts: 1. prevalence assessed by colposcopic examination of the vulva of unselected patients by one doctor (J.M.W.); 2. patients selected by clinical appearance as having vestibular papillomatosis (by J.M.W. and other doctors) assessed in a research clinic. Setting Outpatient genitourinary medicine clinic in South London. Subjects Part 1 study: 295 female clinic attenders; part 2 study: 18 women with clinical vestibular papillomatosis. Main outcome measures Part 1 study: number of unselected patients found to have vestibular papillomatosis. Part 2 study: associated symptoms, histology, DNA hybridisation and polymerase chain reaction on vulval biopsies. Clinical regression of lesions. Cervical cytology and colposcopy. Results Part 1 study: Vestibular papillomatosis was identified by colposcopic examination of the vulva in 3/295 (1%) of women. Part 2 study: 9/18 (50%) women with vestibular papillomatosis were asymptomatic; the other nine had intermittent mild symptoms. Thirteen (72%) had a history of genital warts. Vulval biopsies had features suggestive of wart virus infection on histology in 17/18 (94%) and HPV16 was found by DNA hybridisation studies or polymerase chain reaction in 7/18 (39%). On follow up (mean duration 9 months) the vulval lesions had regressed in 9/12 patients. Ten patients had cervical wart virus infection or intraepithelial neoplasia (CIN), or both, and five needed laser treatment for this. Conclusions In this study vestibular papillomatosis was associated with human papillomavirus (HPV) infection. This study suggests that vestibular papillomatosis need not be treated, but patients with it may be at increased risk for CIN.

Vulvar vestibuler papillomatozis

“…VP histopatolojisi, normal vulvar epitelle kaplı fibrovasküler dokunun parmaksı uzantıları ile karakterizedir. Bazen viral infeksiyonlarda görülen koilositoza benzer vakuolize epitel hücreleri görülebilir, ancak, bunların vestibüldeki epitel hücrelerinin içeriğinde oldukça fazla olan glikojene ve doku proçesi sırasında vakuolize olmalarına bağlı olduğu düşünülmektedir 1,3 . Görünüm olarak genital verrülere benzeyebilen papüller, verrülerden farklı olarak tek tek yerleşirler ve yüzeyleri daha düzdür, verrüler ise daha sert olup tabanlarından birleşme eğilimindedir.…”

“…VP vulvanın anatomik bir varyantı olarak değerlendirilmekte ve erkeklerde görülen incimsi (pearly) penil papüllerin kadınlardaki eşdeğeri olarak düşünülmektedir 1,2 . Prevelansı %1 olarak bildirilmiştir 3 . Ülkemizde VP görülme sıklığı ile ilgili bir çalışma bulunmamaktadır ve yurt içi literatürde konu ile ilgili yayınlar bir olgu bildirimi ile sınırlıdır 4 .…”

Multiple papillae on labia minora

“…1 It is characterized by linear, pink, smooth or filiform papules symmetrically distributed on the inner surface of both labia minora.…”

Vulvar Papillomatosis, Aceto-White Lesions, and Normal-Looking Vulvar Mucosa Evaluated by Microscopy and Human Papillomavirus Analysis

“…The prevalence of VP was estimated to be 1 % of the women examined consecutively in an outpatient gynaeco logical practice [2], However, in a population-based study of 611 young women, it was found that 35% had some degree of papillomatous structure of the inner aspects of the labia minora [3]. Attention needs to be paid to this condition, as many women complaining of itching, burn ing, and dyspareunia are found to have VP [4].…”

“…Attention needs to be paid to this condition, as many women complaining of itching, burn ing, and dyspareunia are found to have VP [4]. Pro nounced VP is observed in many women who have or have had condyloma acuminatum or cervical intra-epi- thelial neoplasia (CIN), giving reason to supsect human papillomavirus (HPV) as an aetiological factor [2], How ever, VP may be totally asymptomatic, and there is a widespread belief that the condition represents a normal but unusual physiological variant of epithelial folding [5,6]. The aim of this study was to determine whether HPV is present in prominent vestibular papillae or filaments seen in women with other signs of HPV infection and in those with severe vulvar itching or pain.…”