Understanding Vulvar Papillomatosis: A Guide

Vulvar or vestibular papillomatosis (VP) are small fingerlike projections on the vulva or vestibule of unknown origin.¹

It is estimated that one per cent of people with biological vaginas have papillomatosis. These little papules are possibly the vaginal equivalent of smooth, flesh-coloured projections found on the corona of the penis (glans), which are called pearly penile papules (PPPs). PPPs are benign and pose no threat to health, but can be too wart-like for many to feel comfortable with.²

There has been some debate regarding whether these papules are related to human papillomavirus, however, the consensus is that they are unrelated.³

Vulvar or vestibular papillomas are thought by some to be an anatomical variant that is benign and not a medical condition. It’s important to have the papules checked in case they are related to a sexually transmitted disease.

Once diagnosed accurately, no treatment is necessary. The papules are not contagious or related to any medical condition.

The HPV link and genital warts

The papillomas can look very similar to genital warts caused by HPV, which is why the link was originally suggested. Studies have been mixed for proving the HPV link, ranging from positive to inconclusive.^4,5

Papule or wart? How to tell

Warts that look similar to papules are often joined at the bottom, however, papules have a stalk that is separate from nearby stalks.⁶

You could compare warts to a head of cauliflower and papules to single asparagus stalks.

Vestibular papillae are pink, and the same colour as the mucosa (tissue) next to it. Papules are soft, linear, and symmetrically distributed, with each base separate from its neighbour.

There is no whitening using the acid test (five per cent vinegar dilution). Warts (condyloma acuminatum) are firm, and random, and will usually go white when vinegar is applied.

Symptoms of vulvar or vestibular papillomatosis

Pink projections, usually symmetrical and lined up on the vulva or vestibule
Sometimes accompanied by pain, burning, itching or tenderness (may be accompanied by dyspareunia or vulvar vestibulitis)
Labia or vestibule may be swollen

Treatment for vulvar or vestibular papillomatosis

Because vestibular or vulvar papillomatosis are considered a normal variant of vulvar/vestibular tissue, no treatment is required unless you are experiencing uncomfortable symptoms.⁷

Some of you will simply hate the look of these little growths and want them removed. Speak to your doctor or dermatologist about removal options.

Removal can be performed via a few methods, including laser treatment. The papules may reappear after removal.

Remember, these are not contagious, are not a disease, and can be normal. Papillomas do not need treatment unless you really want or need it.

If you are suffering symptoms, removal is an option, however other medical conditions will need to be ruled out as the cause of your symptoms. Please see your doctor for advice.

Vulvar or vestibular papillomatosis may also be called:

Hirsutoid papillomas of the vulvae
Vulvar squamous papillomatosis
Micropapillomatosis labialis
Squamous vestibular micropapilloma.
Benign squamous papillomatosis
Vestibular papillomatosis
Hirsuties papillaris vulvae

References

1.
Moyal-Barracco M. Vestibular Papillae of the Vulva. Arch Dermatol. Published online December 1, 1990:1594. doi:10.1001/archderm.1990.01670360058008
2.
Verma S, Wollina U. Vulvar vestibular papillomatosis. Indian J Dermatol Venereol Leprol. Published online 2010:270. doi:10.4103/0378-6323.62971
3.
Bergeron C, Ferenczy A, Richart R, Guralnick M. Micropapillomatosis labialis appears unrelated to human papillomavirus. Obstet Gynecol. 1990;76(2):281-286. https://www.ncbi.nlm.nih.gov/pubmed/2164653
4.
Fu YL, Hu YX, Ling HL, et al. Human Papillomaviruses and Papillomatosis Lesions of the Female Lower Genital Tract. Infectious Diseases in Obstetrics and Gynecology. Published online January 1994:235-241. doi:10.1155/s1064744994000153
5.
Hung SH, Yang TH, Cheng YF, Lin HC, Ho JD, Chen CS. Association of peripheral vestibular disorder with human papillomavirus infections. Eur Arch Otorhinolaryngol. Published online March 14, 2025. doi:10.1007/s00405-025-09283-2
6.
Kim SH, Seo SH, Ko HC, Kwon KS, Kim MB. The use of dermatoscopy to differentiate vestibular papillae, a normal variant of the female external genitalia, from condyloma acuminata. Journal of the American Academy of Dermatology. Published online February 2009:353-355. doi:10.1016/j.jaad.2008.08.031
7.
Ozkur E, Falay T, Turgut Erdemir AV, Gurel MS, Leblebici C. Vestibular papillomatosis: An important differential diagnosis of vulvar papillomas. Dermatology Online Journal. Published online 2016. doi:10.5070/d3223030368