Benign vulvar lesions
- Lesion
A blocked gland, two white itchy skin conditions and the genital wart: the common benign lesions of the vulva and how to tell them apart.
What it is
Most vulvar lumps and white patches are benign. A Bartholin cyst forms when the duct of the gland is blocked. Lichen sclerosus thins the epidermis and scars the dermis; lichen simplex chronicus thickens the epidermis after chronic rubbing. Condyloma acuminatum is the low-risk HPV wart. Because white patches (leukoplakia) can also be dysplasia or carcinoma, only a biopsy settles the diagnosis.
Structure
- Bartholin cyst: a unilateral cyst near the posterior vestibule, up to several centimetres, lined by transitional epithelium, squamous metaplasia or flattened cells; an abscess fills it with neutrophils.
- Lichen sclerosus: white plaques or papules that merge; under the microscope a thinned epidermis over a homogeneous, collagen-rich, cell-poor upper dermis and a band of lymphocytes below it.
- Lichen simplex chronicus: leathery white plaque; acanthosis, thick keratin layer and chronic inflammation, without atypia.
- Condyloma acuminatum: soft, red-pink to tan, exophytic papillary lesions; acanthosis, papillomatosis and koilocytes (enlarged, wrinkled, dark nuclei with a clear halo).
Step by step
- Bartholin duct obstruction by infection or trauma traps secretions and the gland dilates into a cyst.
- In lichen sclerosus, a T-cell–mediated attack on the dermal-epidermal junction damages basal cells and replaces the upper dermis with dense collagen.
- In lichen simplex chronicus, an itch-scratch cycle makes the epidermis thicken in response to repeated trauma.
- In condyloma, low-risk HPV infects basal cells through microabrasions and drives a productive infection that builds a papillary wart.
White vulvar lesions and the wart
| Lesion | Epidermis | Dermis | Cancer risk |
|---|---|---|---|
| Lichen sclerosus | Thin, flat, basal vacuolar change | Pale hyalinised band with lymphocytes beneath | Small increase (HPV-independent carcinoma) |
| Lichen simplex chronicus | Thick (acanthosis), hyperkeratosis | Chronic inflammation | Not premalignant itself |
| Condyloma acuminatum | Papillary, koilocytes | Fibrovascular cores | Not premalignant (low-risk HPV) |
Clinical notes
- Bartholin cysts cause pain and pressure; abscesses are drained, and a new solid mass in an older woman is biopsied to exclude carcinoma.
- Lichen sclerosus affects mainly postmenopausal women but also girls; it causes itch, painful intercourse and scarring.
- Condyloma latum of secondary syphilis can look similar but is flat and moist; condylomas can multiply in pregnancy and immunosuppression.
Test yourself
Think of the answer, then tap the question to see it.
What are the microscopic features of lichen sclerosus?
A thinned epidermis with loss of rete ridges and basal vacuolar change over a pale hyalinised band of dermal collagen, with lymphocytes beneath the band.
Which HPV types cause condyloma acuminatum, and is it premalignant?
Low-risk HPV 6 and 11; the warts are not considered premalignant.
Why is a white vulvar patch biopsied?
Leukoplakia is only a clinical description: lichen sclerosus, lichen simplex chronicus, vulvar intraepithelial neoplasia and carcinoma can all look white.
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Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.
Sources: Bartholin Gland Cyst (StatPearls (NCBI Bookshelf), 2026); Human Papillomavirus (StatPearls (NCBI Bookshelf), 2026).
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Representative model, for educational purposes only.