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Pseudocondyloma of the vulva

OVERVIEW

What is pseudocondyloma of the vulva?

Pseudocondyloma of the vulva, also known as "hirsutoid labia minora," is a type of pseudopapilloma that occurs on the inner side of the labia minora, with a few cases involving the vaginal vestibule and vaginal opening. It appears as raised, pale red papules on the female genital area, usually without noticeable symptoms or accompanied only by mild itching [1]. Due to its resemblance to condyloma acuminatum, many people confuse the two.

Is pseudocondyloma of the vulva common?

It is relatively common. Pseudocondyloma of the vulva is more frequently seen in young women, whether married or unmarried, with the onset age mainly between 18 and 40 years old [1].

Is pseudocondyloma of the vulva a disease?

Pseudocondyloma of the vulva is a benign proliferative condition [2].

Many healthy women are born with pseudocondyloma, which can be considered a normal physiological variation. In such cases, it is not a disease. However, some women may develop pseudocondyloma or experience an increase in existing lesions due to chronic inflammation or prolonged irritation from vaginal discharge. In these cases, treatment for gynecological inflammation may be necessary.

Is pseudocondyloma of the vulva a sexually transmitted disease?

No.

Pseudocondyloma of the vulva is a benign papillary tumor occurring in the female genital area and is not a sexually transmitted infection. However, unprotected sexual activity may increase the risk of infections in the vulvar region, which could trigger this condition.

Which department should I visit for pseudocondyloma of the vulva?

Generally, you can consult the gynecology or dermatology department.

SYMPTOMS

What are the manifestations of pseudocondyloma of the vulva?

The clinical characteristics of female pseudocondyloma are as follows [2]:

  1. Affected population: The disease is more common in young women, whether unmarried or married, with an insidious onset;
  2. Distribution sites: The inner sides of both labia minora, vaginal orifice, urethral orifice, etc.;
  3. Rash manifestations:
    1. Mostly symmetrically and evenly distributed, pale red or pale white fish-egg-like, villous, or polypoid small papules, 1–2 mm in size, with a smooth surface, densely arranged without fusion, and a granular texture upon touch;
    2. The rash grows slowly or stagnates, lacks self-limitation, and does not disappear on its own. Even after eliminating various long-term chronic inflammatory stimuli, it may not necessarily alleviate and is difficult to resolve;
    3. No obvious subjective symptoms or mild itching.

CAUSES

What causes pseudocondyloma of the vulva?

The exact cause of pseudocondyloma of the vulva remains unclear, but it may be associated with the following factors:

  1. Genetics: For pre-existing physiological variations, this is genetically determined. Individuals with a family history of the condition have a higher probability of developing it compared to the general population [2].
  2. Inflammatory stimulation: Inflammation in the vulvar area, such as candidal vaginitis or trichomonal vaginitis, and long-term secretion irritation may trigger the onset of this condition [2].

What are the predisposing factors for pseudocondyloma of the vulva?

  1. Poor vulvar hygiene: Infrequent changing of underwear or not washing the vulva daily, especially during menstruation, can easily lead to vaginal inflammation. If not controlled in time, it may further induce this condition.
  2. Mechanical damage: Factors such as wearing tight pants or cycling can cause friction and compression, damaging the vulvar mucosa and triggering this condition [1].
  3. Excessive vulvar cleaning: Frequent washing of the vulva may disrupt the protective function of the vulvar mucosa and lead to this condition.

Is pseudocondyloma of the vulva contagious?

Pseudocondyloma of the vulva is not a contagious disease and cannot be transmitted [2].

Is pseudocondyloma of the vulva hereditary?

This condition has a certain degree of heritability and may be related to genetics, but the exact mechanism has not been fully studied [2].

DIAGNOSIS

How is pseudocondyloma of the vulva diagnosed?

Doctors typically diagnose it based on clinical manifestations, combined with physical examination and relevant auxiliary tests (dermoscopy, vaginal secretion examination, acetic acid whitening test, pathological examination, HPV testing, etc.).

  1. Physical examination involves a preliminary visual assessment;
  2. Dermoscopy is used to observe the affected skin areas;
  3. Vaginal secretion examination checks for fungal or trichomonas infections;
  4. Acetic acid whitening test helps rule out condyloma acuminatum;
  5. Pathological examination assists in confirming pseudocondyloma;
  6. HPV testing excludes human papillomavirus infection.

What tests are needed if pseudocondyloma of the vulva is suspected?

  1. When pseudocondyloma is suspected, doctors visually inspect the rash's appearance and morphology;
  2. Dermoscopy allows detailed observation of the lesions to aid diagnosis.
  3. An acetic acid whitening test can be performed, with negative results expected;
  4. If inflammation or secretion irritation is suspected, vaginal secretion examination is required;
  5. A small tissue sample from the lesion is taken for pathological sectioning and microscopic observation to confirm diagnosis [2];
  6. Polymerase chain reaction (PCR) detects HPV DNA, typically negative in this condition.

Why are acetic acid whitening and secretion tests performed for pseudocondyloma of the vulva?

  1. Acetic acid whitening test: Differentiates pseudocondyloma from condyloma acuminatum. A low-concentration acetic acid solution is applied to the rash; after 3–5 minutes, whitening indicates condyloma, while pseudocondyloma shows no change. Medical-grade acetic acid must be used, so this test should be done in a proper hospital.
  2. Secretion examination: If vaginal secretion irritation is suspected, secretions are collected (from the posterior fornix in sexually active women) and examined microscopically for fungi or trichomonas. This is usually performed in a gynecology clinic [3].

What diseases can pseudocondyloma of the vulva be confused with? How to differentiate them?

It is often confused with condyloma acuminatum. Experienced doctors can distinguish them by rash morphology. Pseudocondyloma typically appears pink, smooth, and fish egg- or villus-like, with non-fused lesions and a negative acetic acid test. Condyloma acuminatum has a rough, cauliflower-like surface, may fuse into large patches, and tests positive for acetic acid whitening [3].

If a vulvar rash is noticed, consult a dermatologist at a reputable hospital. Avoid unlicensed clinics that may misdiagnose pseudocondyloma as condyloma, leading to unnecessary expenses and psychological stress.

TREATMENT

Does vulvar pseudocondyloma need treatment?

Physiological pseudocondyloma does not require treatment, but if it is caused by vaginal inflammation, the inflammation should be actively treated [4].

Can vulvar pseudocondyloma disappear on its own? Will it increase in number?

It generally does not disappear on its own and tends to persist long-term. If inflammation or secretions continue to irritate the area, pseudocondyloma may increase in number.

What methods are available to remove vulvar pseudocondyloma?

For women who strongly desire removal, methods such as liquid nitrogen cryotherapy or laser therapy can be used [4].

  1. Liquid nitrogen cryotherapy: Liquid nitrogen is applied to the affected area. This method is simple and minimally invasive, but one session may not be sufficient, requiring a second or multiple treatments.
  2. Laser therapy: After local anesthesia is administered, the lesions are burned off using an electric ion or laser. Typically, one session is enough for complete removal.

What are the risks of treating vulvar pseudocondyloma? Can it cause other conditions?

Possible risks include scarring and infection.

  1. Liquid nitrogen cryotherapy: Applying liquid nitrogen to the lesions [3]. Although simple and minimally invasive, potential adverse reactions include:
    1. Significant pain;
    2. Varying sizes of blisters post-treatment—some may be small and manageable, while others may require drainage with a sterile syringe and avoiding water contact for about three days;
    3. Multiple treatment sessions may be necessary.
  2. Laser therapy: After local anesthesia, lesions are burned off using an electric ion or laser [3]. Risks and complications may include:
    1. Noticeable pain during anesthesia injection;
    2. Risk of infection post-treatment—avoid water contact for 3–5 days and apply topical antibiotics like mupirocin;
    3. Possible poor wound healing.

Is follow-up necessary for vulvar pseudocondyloma? Why?

Some patients may require it.

For pseudocondyloma caused by inflammation or secretions, follow-up is needed to monitor the improvement or resolution of the inflammation. If it is a pre-existing physiological variation, follow-up is unnecessary.

Can vulvar pseudocondyloma recur?

It generally does not recur after treatment, but if inflammation reoccurs, pseudocondyloma may develop again.

DIET & LIFESTYLE

What should patients with pseudocondyloma of the vulva pay attention to in diet and daily life?

  1. There are no specific dietary restrictions for this condition. A light diet is recommended, meaning daily intake should be low in oil (25–30g), salt (<5g), and sugar (<50g). Eat more fresh fruits and vegetables (apples, oranges, grapes, etc.), dairy products (milk, yogurt, etc.), and grains (corn, sweet potatoes, etc.) to maintain a balanced nutrition [5].
  2. Maintain a regular daily routine, change clothes frequently, and wash the vulva with warm water daily. If abnormal vaginal discharge (yellowish with an odor) occurs, seek timely treatment.
  3. Keep the affected skin clean and dry. Avoid scratching to prevent secondary infections.
  4. Patients should face the condition objectively and consult professional doctors to learn about pseudocondyloma. In some cases, it may be a normal physiological phenomenon, so excessive anxiety is unnecessary.

Does pseudocondyloma of the vulva affect fertility?

Pseudocondyloma of the vulva is a benign hyperplastic condition and does not affect fertility itself. However, if other severe gynecological inflammations (such as candidal vaginitis or trichomonal vaginitis) are present, vaginal inflammation may hinder sperm motility or even cause sperm death. The impact on fertility should be assessed based on the specific condition [2,6].

PREVENTION

Can Pseudocondyloma of the Vulva Be Prevented?

The exact cause of pseudocondyloma of the vulva remains unclear, and there are currently no effective preventive measures. However, since it is associated with vulvitis and chronic irritation, avoiding related triggers may help reduce the risk.

  1. For congenital physiological variations, prevention is not possible;
  2. Maintain daily hygiene by washing the vulva with warm water, change underwear frequently, avoid frequent or unprotected sexual activity (e.g., not using condoms), and reduce the risk of infections;
  3. Seek prompt gynecological consultation if experiencing vulvar itching, abnormal vaginal discharge, or unusual odor.