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A 34-year-old woman presented to her primary care physician with vulvar pruritus, which she reported having had for several months. A diagnosis of condyloma on the vulvae was made, and the patient was referred for treatment. Many flesh-colored, soft pearly papules, which were 1 to 2 mm in diameter, with some grouped and some discrete, were observed on the inner aspects of her labia minora. These papules were linearly distributed and symmetrically located along both inner sides of the vulvae (arrows). Grouped projections on the right inner labium minus were easily separated from each other on examination. The shiny, soft, linearly arrayed papules are the typical presentation of vestibular papillomatosis, a variant of vestibular mucosa commonly mistaken for genital warts. Clinically, genital warts, or condyloma, are not confined to the vestibule. Filiform or cauliflower projections of condyloma tend to fuse at the base. When 5% acetic acid is applied to condyloma acuminatum, a whitening typically occurs; with vestibular papillomatosis, there is usually no whitening. Vestibular papillomatosis is a normal vulvar anatomical condition that can be seen as the female counterpart of male pearly penile papules. A correct diagnosis of vestibular papillomatosis prevents unnecessary concern and laboratory tests.
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