Indian Journal of Gynecologic Oncology - Exuberant Vulval Vestibular Papillomatosis (VVP): A Rare Enigma Treated with the Help of the “Workhorse” of Vulva Reconstruction - V–Y Advancement Flap

Sep 5, 2026

Vulval vestibular papillomatosis (VVP) is a benign vulvar condition that is frequently mistaken for genital warts by both gynecologists and dermatologists. Low prevalence leads to repeated mismanagement, unnecessary treatment, and avoidable patient discomfort. A case is presented in which growth persisted due to prior incorrect therapies, followed by wide local excision and bilateral V–Y plasty for tension-free primary repair. Uneventful recovery occurred, and histology details, including V–Y reconstruction specifics, are described to support accurate recognition and avoid unwarranted investigations.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages4

Reading Time10 min

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Abstract

Keywords

Introduction

Case Report

Clinical Presentation

Investigations and Diagnosis

Treatment

Post-operative Course and Histopathology

Indian Journal of Gynecologic Oncology (2025) 23:70 [https://doi.org/10.1007/s40944-025-00959-5](https://doi.org/10.1007/s40944-025-00959-5) Exuberant Vulval Vestibular Papillomatosis (VVP): A Rare Enigma Treated with the Help of the “Workhorse” of Vulva Reconstruction—the V–Y Advancement Flap Dimpy Begum1 · Debabrata Barmon1 · Upasana Baruah1 · Gaurav Das2 · Shiraj Ahmed3 · Karthik Chandra Bassetty1 Received: 14 March 2024 / Revised: 18 July 2024 / Accepted: 31 December 2024 / Published online: 28 April 2025 © The Author(s) 2025 Abstract Vulval vestibular papillomatosis (VVP) is a benign condition of the vulva often confused with warts by both gynaecologistsand dermatologists. Owing to its uncommon prevalence it is mistaken for warts and treated with podophyllum or trichloroacetic acid. We present one such case where the patient had growth of the VVP due to repeated mismanagement. She underwent wide local excision followed by bilateral V–Y plasty to achieve a tension-free primary repair of the defect. She recovered uneventfully. We would like to highlight this "rare" clinical entity to avoid unnecessary investigations and discomfort to patients. The histology is also described in detail with specific mention of the specifics of the V–Y plasty reconstruction. Keywords Vulval vestibular papillomatosis · V–Y plasty · Warts · Unusual presentation Introduction Vulvar vestibular papillomatosis is an anatomical variant of the vulva and is often misdiagnosed as genital warts due to its "wart-like appearance" [1]. The prevalence varies according to various sources ranging from 1 to 5%. Often misdiagnosed by both dermatologists and gynaecologists as warts, it is often treated unsuccessfully leading to anguish for patients and caregivers. We present such a case where the patient had undergone multiple modes of treatment before presentation to our institute where she underwent wide local excision followed by bilateral VY plasty to achieve primary closure of the defect. * Karthik Chandra Bassetty [kcbassetty@gmail.com](kcbassetty@gmail.com) 1 Department of Gynaecological Oncology, Dr B.Borooah Cancer Institute, Guwahati, India 2 Department of Surgical Oncology, Dr B.Borooah Cancer Institute, Guwahati, India 3 Department of Oncopathology, Dr B.Borooah Cancer Institute, Guwahati, India Case Report A 56-year-old postmenopausal woman presented to Dr. Bhubaneswar Borooah Cancer Institute, Guwahati, Assam with a history of exuberant vulval growth for the past six months which gradually increased in size. She experienced severe discomfort due to the large size of the lesion, irritation and burning sensation on the contact of the lesion with urine. She had visited two gynaecologists before attending our OPD and after undergoing multiple biopsies, she was treated with Podophyllum paint for one month and also underwent one session of chemical cautery with trichloroacetic acid. The biopsy was reported as mild verrucous hyperplasia. The patient was multiparous and was in a monogamous relationship. On examination, as shown in Fig. 1 there were two large 15*5*7 cm bilateral lesions with multiple fingerlike elongated papules which were skin coloured, appeared digitate and involved both the labia majora and posterior portion of the labia minora sparing the clitoris [1 cm away] and urethra [3 cm away] and involving up to the margins of the anus. The lesion was friable however no bleeding was noted and was tender due to the extensive size of the lesion. Surrounding skin was normal and per speculum examination of the vagina and cervix was normal. Liquid-based cytology was suggestive of Negative Fig. 1 Examination of the vulva lesion shows multiple finger-like projections involving the labia majora and posterior aspect of the labia minora for intraepithelial lesion or malignancy(NILM).On application of 5% acetic acid, there were no acetowhite areas. The review of the biopsy in our Institute was suggestive of hyperkeratot

FAQs

Why is vulval vestibular papillomatosis (VVP) often misdiagnosed?

VVP is a benign vulvar anatomical variant that has a wart-like appearance, so it is commonly mistaken for genital warts by both gynecologists and dermatologists.

What treatments did the patient receive before the correct diagnosis and surgery?

The patient underwent podophyllum paint and one session of chemical cautery with trichloroacetic acid, and the biopsy initially suggested mild verrucous hyperplasia.

How was the condition treated after presentation, and what was the outcome?

The patient underwent wide local excision followed by bilateral V–Y plasty to achieve tension-free primary closure; recovery was uneventful and she was discharged on postoperative day 24.

Sep 5, 2026

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