Worried about possible
warts
I am 34 years old. I am worried I may have vaginal warts or
something. I don't know what they are but they are new growths on my
outer labia. I thought maybe they were "skin tags" and not
anything to worry about but I seem to be getting a few more. Now one of
them is sensitive, almost painful.
I have a regular D.O I see for my medical concerns but I am
embarrassed to ask him about them. Please let me know if I should go
have them checked out.. and if you might know what they are. I realize I
have to go sometime because they are beginning to really make me self
conscious sexually. If they are not a medical concern, they are at least
becoming a personal one.
Growths like you describe on the vulva cannot really be diagnosed by
description. You need to have your doctor look at them. Don't be
embarrassed. Your doctor has probably seen those many times if they
are warts (condyloma accuminata). What you have described can be
consistent with condyloma but there are other possibilities also.
If the doctor thinks that's what they are, ask about treatment with
Aldara®. This is a relatively recent treatment (cream) that allows
you to treat at home three times a week. It is much less painful than
the older treatments of chemicals that "burned". In my
experience it has been quite effective.
Are you a smoker or do you have any conditions affecting the immune
system? If you do, it may take a while to clear condyloma up.
Labial growth for a long
time
I am 21 and for as long as I can remember I have had a small
growth on the outside of my labia minor. I have never had a doctor check
it out. Is this something that I should worry about?
It is not possible to say for sure without seeing the growth you are
talking about. In general, if something like that has been present for
many years and not changed in size, color, or firmness, it is most
likely to be benign and possibly even congenital (from birth). At age
21 you might consider seeing a physician who does pelvic exams. See
what that physician says.
Clitoral and vulvar sores
Over the past 4 years I have developed some unusual symptoms that
many doctors cannot explain...tests are negative, therefore they do not
know how to treat me.
Initially, the area around my clitoris (lips ?) becomes irritated,
itchy and after about 2 days, the area becomes extremely sensitive and a
clear sheath covers a small bloody area...not like a herpes sore. The
sore is sort of long in shape, bloody, under a clear sheath, which comes
off after I wipe, and is bloody underneath. The Dr. states it is NOT
herpes even though I do test positive.
Now... not only does my vaginal area become infected by whatever
this is but now my left eye become puffy, itchy, red and on the first
day has a little bit of puss come out of it. The puffiness and redness
continues for about a week...usually goes away before vaginal area is
healed. Now..this past time I have an outbreak which includes my vagina,
eye and now my lips and mouth are completely swollen and cracked and
bloody. It seems each time I have an outbreak of whatever this is the
next time I get it a new symptom accompanies all the others. The doctors
think it is viral but I need to know if you have ever heard of anything
like this.
I initially was put on Zovirax® which did not seem to help AT
ALL...that is why they didn't think it was herpes. I am 34 years old,
and my history includes osteogenic sarcoma at age 10 resulting in
amputation and chemotherapy for 1.5 years. Could the chemotherapy
possibly have compromised my immune system in some way. Blood tests
always come back normal, as well as pap tests...I have had many tests
and NO-ONE knows what this is.
The most problematic of all symptoms is vaginal area because it is
very sensitive and bleeding. The bleeding does not come from my vagina.
How can I heal it and is there anything I can do to prevent whatever
these outbreaks are? I am DESPERATE for help here. The various doctors I
have seen are clueless...so I am turning to anywhere possible for help.
Thank you very much...
You describe a complex and unusual set of symptoms. It is difficult
to diagnose any skin lesions without seeing them. A couple of things
do come to mind about this.
The course you describe is consistent with viruses of the herpes
family. When you said you tested positive for herpes, was that by
culture or by blood antibodies? If it was by culture of the lesions,
than this is a herpes infection even though it may not appear "typical".
I assume that repeated cultures of the lesions have been done and
herpes has not grown out with any of them. (it often difficult to
culture herpes so I would say you need at least three attempts at
culture before concluding this is not a herpetic outbreak). Make sure
the doctor cultures or smears for chlamydia species since these are
known to affect both the genital area and the eyes. You could have an
unusual strain.
Herpes lesions can be long rather than round and often coalesce to
be large. Zovirax® and other anti-herpetic medications don't
really cure herpes. At best, taking it chronically can reduce the
frequency of outbreaks, but the outbreaks still occur.
I have seen staph/strep bacterial infections that can look like
herpetic lesions. I suspect they must have been very unusual strains
because this is uncommon, but in those cases there was response to
penicillin-type antibiotics to reduce episodes. Have you had any
empirical trials of antibiotics?
The immune system definitely does play a role, especially if these
are viral in origin. Be sure your thyroid tests are normal and that
you don't have any liver disease such as hepatitis C or B or any HIV.
Stress can play a role in herpes outbreaks so any stress reduction may
help at least with the frequency.
Have any of the doctors you've seen been dermatologists?
Gynecologists usually do ok with vulvar lesions but your problem is
systemic and if you haven't seen an experienced dermatologist, that is
one suggestion I could offer.
Vulvar lichen sclerosis
I think this site is very useful. My wife went for ten years with
lichen sclerosus (fully manifested) on her vulva without her doctor
diagnosing it. Finally this doctor was going to operate for a fused
labia and my wife went to another doctor for a second opinion. In two
seconds he knew it was -- lichen sclerosus and suggested a biopsy which
we did.
To think of what we went through for ten years. My wife had an
acute case and would often have her skin tear. A few times a year the
always swollen area would rip and then get infected. This doctor had her
sitting in a bathtub until it got so large it popped open. Sometimes it
was eight days of suffering. We couldn't have sex much of the time
during these ten years and when we could it was difficult for her.
The first doctor said there was nothing we could do. Temovate®
finally took care of it in a few months once we had a proper diagnosis.
I don't know what this doctor thought were all these white lesions and
white staining all over. The more on the internet the better.
Thanks very much for your comments. It has only in recent years been
shown that lichen sclerosis responds to anything. Temovate® 0.05%
(clobetasol, a steroid cream) is now the treatment of choice. I've
only known about it for about 4 years. It takes awhile for medical
knowledge to disseminate and the volume is tremendous.
Vestibular pain, keratosis
and vulvitis
I've been experiencing vestibular pain for about 3 years, and itchy
spots on different parts of my vulva that have appeared and worsened
over the past year. I've had 4 biopsies done within the past year, and
the diagnosis is keratosis and chronic vulvitis, with a thickening of
the affected cells, especially of the vestibule. My doctor doesn't know
what to do and I've been waiting for months for her to get back to me. I
wonder if anyone might know how keratosis starts and how it's treated.
I have never had any problems with my scalp whatsoever, and can
only find information about keratosis affecting parts of the body that
have been overexposed to the sun. I'm 26 years old and fair skinned.
The question about keratosis is difficult to answer because as a
pathological change it is generalized. On the vestibule of the vulva
(moist keratinized epithelium) it can simply be a reaction to chronic
itching or rubbing and the entity you have would be vulvar
vestibulitis. In that case its the chronic inflammatory response that
needs to be treated.
If the keratosis is on the dry skin of the vulva (where the hair
is), then the entity you are concerned about is seborrheic keratosis
like one might get in the scalp. That usually has raised red or
yellowish pink lesions that are similar to those in the scalp and
usually don't have to be biopsied because they are typical. Vulvar
vestibulitis usually doesn't have a visible raised lesion but it is
merely red in color and sometimes just looks inflamed.
Vulvar vestibulitis is very difficult to treat. Many treatments have
been tried but I know of none that are more than 50% successful. They
range from applying cremes to injections to surgery that removes the
skin. Sometimes this problem will just go away after several years. It
must be some sort of infectious or inflammatory process because of the
inflammatory cells that appear just under the dermis on biopsy. Many
infectious agents have been looked for but none identified as the most
likely cause.
Ask your doctor what entity she thinks this is. I'm sure she has
heard of vulvar vestibulitis and her hesitation in getting back to you
might be because of the poor treatment for this condition. Seborrheic
keratosis, which is an entirely different process responds to steroid
creams. The reason to know for sure is because you may need to see
someone who specializes in vulvar disease. I've only seen about 10-12
of these in 29 years of Ob-Gyn so it's not very common for the general
gynecologist.
What causes seborrheic
keratosis?
The first problems occurred at the vestibule, but then just over a
year ago I noticed the itchy patches on the dry skin of my vulva, so, as
you say, that would be seborrheic keratosis. Can you tell me what might
be causing it?
Cause for seborrheic keratosis is unknown.
Red patches on the dry
vulvar skin getting larger
The patches are slightly red in color and the affected area is
getting larger! It started with just one small spot, but now a large
part of the dry skin is affected.
There is another entity that this could represent. Seborrheic
keratosis is a somewhat "waxy", but not moist lesion. If the
lesion is dry and "scaly" (and getting bigger) it could also
represent psoriasis, or even a fungal infection such as tinea cruris,
tinea corpora. Sometimes the dermatologist would be better to see than
the gynecologist to diagnose lesions out on the dry skin.
Vulvar cancer and HPV 16
Is it possible to have vulvar cancer without testing positive for
HPV 16 ?
Not all vulvar cancers are positive for human papilloma virus (HPV)
16. See the following abstract. In that study, 60% of the women with
vulvar cancer were positive for any HPV DNA. Younger patients
with vulvar cancer tend to test positive for HPV 16 in a higher
percent and smokers were more likely to be positive. Also, HPV
positivity varied by the type of vulvar cancer. In that study, only
39% of the typical squamous cell type of vulvar cancer was positive
for HPV while 95% of the verrucous, warty, or basaloid type were
positive.
Obstet Gynecol 1995 May;85(5 Pt 1):709-715
Prognostic significance of human papillomavirus DNA in vulvar
carcinoma.
Monk BJ, Burger RA, Lin F, Parham G, Vasilev SA, Wilczynski SP
Department of Obstetrics and Gynecology, University of California
Irvine Medical Center, Orange,USA.
OBJECTIVE: To determine the histopathologic, epidemiologic,
and prognostic significance of
human papillomavirus (HPV) DNA in primary invasive vulvar cancer.
METHODS: From December 1981 through October 1992, primary
tumor tissue from 55 newly diagnosed vulvar cancers was evaluated for
the presence of HPV DNA. The DNA was extracted from tumor tissue and
subjected to the polymerase chain reaction (PCR) using highly
conserved consensus L1 primers that detect 25 different HPV genotypes
and primers specific for HPV type 6/E6, type 16/E7, and type 18/E6
gene sequences. All PCR products were hybridized to type-specific
radiolabeled probes. The association between the presence of HPV DNA
and histologic, epidemiologic, and clinical characteristics was
analyzed.
RESULTS: Thirty-three (60%) tumors contained HPV DNA.
Patients younger than 70 years of age or who smoked were more likely
to have HPV-positive vulvar cancers. Twenty-one (95%) of 22 tumors
classified as basaloid, warty, or verrucous contained HPV DNA, whereas
12 (39%) of 31 typical squamous tumors contained HPV (P < .001).
Two adenocarcinomas were negative for HPV. Tumors with or without HPV
DNA did not differ with respect to International Federation of
Obstetricians and Gynecologists stage (size and nodal status), tumor
grade, or therapy. Using life-table analysis, the absence of HPV DNA
and the presence of regional nodal metastasis were predictive of
recurrence and death from vulvar cancer. When controlling for lesion
size, age, tumor grade, and nodal metastasis using the Cox
proportional hazards model, only HPV status remained an independent
prognostic factor.
CONCLUSION: Human papillomavirus DNA is more common in
vulvar cancers of young women who smoke than in older nonsmokers.
Patients with HPV-negative tumors are at an increased risk of
recurrence and death from vulvar cancer.
Itching, bruised, purple
discoloration of vulvar skin
I am a 25 yr. old, mother of a 7 1/2 month infant. Have not had
intercourse for approximately 1 1/2 weeks. My last menstrual cycle ended
2 1/2 wks ago.
The following symptoms presented 1 week ago beginning with
irritation, itching, bruised sensation of labia and vulva. Purple/dark
discoloration. One side of labia appears stretched or enlarged. Some
odor (I know it's there, my husband says he doesn't notice). White or
clear normal discharge. What is this discoloration of the skin?
Very difficult to say without seeing but sounds like a reaction to
vulvar inflammation (not vaginal) but could also be venous blood or
old hemorrhage.
Could this be a symptom of vaginitis?
Probably not primarily a vaginitis. Could be reaction of vulva to
infection or allergy. Allergies to condoms, spermicides, lubricants,
soaps and any deodorants put on the vulva are fairly frequent. I
assume the problem started with itching about 3 days after
intercourse. It could be a reaction to the scratching with or without
a skin, hair follicle or sweat gland infection.
Spontaneous vulvar hematoma or hemorrhage is uncommon. It can happen
after delivery but usually much more like hours to days, maybe 1-2
weeks. Thrombosis of a varicose vein in the vulva can happen just like
in legs or a hemorrhoid but usually there is quite a bit of pain or
discomfort with this. Sometimes a varicose vein can just pop out
there. Most vulvar hemorrhages (if that's what this is) are due to
some trauma like a straddle injury due to bicycle, skiing, amusement
park rides etc. Rarely women can get spider bites when camping or
other insect bites that can produce discoloration but there is usually
a point of skin breakage that gives a clue.
This needs to be looked at by physician because if there is any
bleeding in the vulva, infection can be a real problem. If it's just a
varicose vein it may be followed but the doctor should be able to tell
if the swelling is soft like a vein, brawny like a skin
inflammation/infection, or discrete like an underlying vulvar mass. If
it's a skin infection, it will need antibiotic treatment and possibly
drainage.
Round, flesh-colored bump above labia
I have been in a monogomous relationship for the past 7 months.
Before that, I was in a monogomous relationship for two years,(we
lost our virginity to each other.) While treating a yeast
infection, I noticed a small, round, flesh-colored bump right
above my labia. I doubt that it could be a wart, since neither of
my partners have any signs or diseases, and I just had an exam 5
months ago that found nothing.
These two facts don't rule against genital warts (condyloma
accuminata) since they can grow quickly and partners can be
exposed but not get any visible lesions.
Could it be something else?
Yes. There are other dermatological lesions that frequently
occur, but the most common flesh-colored leson is condyloma
accuminata.
There is no pain, itching, or inflammation. Could it just be a
cyst?
Epidermoid cysts are quite common but usually they present as a
bump under the skin rather than a flesh-colored lesion on the
skin. Hair follicle or sweat gland cysts can be on the vulva but
they appear red rather than flesh colored because usually there
is a low grade inflammation present. You need to see your
gynecologist for diagnosis.
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