[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [General pathology](https://durgical.com/en/general-pathology/) › [Female genital tract](https://durgical.com/en/general-pathology/areas/female-genital/) › Benign vulvar lesions

# 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.

Updated Nov 12, 2026

## Key points

- Bartholin cyst: obstructed duct, lined by transitional or squamous epithelium; can become an abscess (gonococcus or mixed flora).
- Lichen sclerosus: thin epidermis, loss of rete ridges, basal vacuolar change, band of pale hyalinised collagen with lymphocytes beneath; parchment-like white skin, shrinking labia and introitus.
- Lichen sclerosus is probably autoimmune and carries a small risk of HPV-independent squamous carcinoma.
- Lichen simplex chronicus: thick epidermis (acanthosis), hyperkeratosis and dermal inflammation from scratching; not premalignant by itself.
- Condyloma acuminatum: HPV 6 and 11, papillary warts with koilocytes; also on perineum, vagina and cervix; not premalignant.

## 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](https://durgical.com/en/conditions/vulvar-lichen-sclerosus-and-vulvar-cancer/) | 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](https://durgical.com/en/conditions/viral-warts/) | 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.

## Memory aid

Sclerosus subtracts (thin skin, scarred dermis), simplex stacks (thick skin from scratching), and the wart waves its fingers.

## 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.

[Add to my cards (3)](https://durgical.app/estudiar/?add=/en/general-pathology/benign-vulvar-lesions/)

[More Pathology questions →](https://durgical.com/en/practice/?f=pathology)

## Elsewhere in DurgiPedia

- [Skin: epidermis layers, dermis, hypodermis](https://durgical.com/en/histology/skin-epidermis-layers-dermis-hypodermis/)

## Connections

## Related 6

- [Vulvar neoplasia](https://durgical.com/en/general-pathology/vulvar-neoplasia/)
- [Infections of the vulva, vagina and cervix](https://durgical.com/en/general-pathology/infections-of-the-vulva-vagina-and-cervix/)
- [Penile tumours](https://durgical.com/en/general-pathology/penile-tumours/)
- [The anal canal: haemorrhoids, condyloma and anal carcinoma](https://durgical.com/en/general-pathology/the-anal-canal-haemorrhoids-condyloma-and-anal-carcinoma/)
- [Atrophy](https://durgical.com/en/general-pathology/atrophy/)
- [Metaplasia](https://durgical.com/en/general-pathology/metaplasia/)

## Related conditions 7

- [Bartholin gland cyst and abscess](https://durgical.com/en/conditions/bartholin-gland-cyst-and-abscess/)
- [Vulvar lichen sclerosus and vulvar cancer](https://durgical.com/en/conditions/vulvar-lichen-sclerosus-and-vulvar-cancer/)
- [Viral warts (verruca)](https://durgical.com/en/conditions/viral-warts/)
- [Human papillomavirus (HPV) infection](https://durgical.com/en/conditions/human-papillomavirus-infection/)
- [Lichen planus](https://durgical.com/en/conditions/lichen-planus/)
- [Gonorrhoea](https://durgical.com/en/conditions/gonorrhoea/)
- [Syphilis](https://durgical.com/en/conditions/syphilis/)

## Microorganisms 2

- [Human papillomavirus](https://durgical.com/en/microbiology/human-papillomavirus/)
- [Neisseria gonorrhoeae](https://durgical.com/en/microbiology/neisseria-gonorrhoeae/)

[← All of general pathology](https://durgical.com/en/general-pathology/)

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](https://www.ncbi.nlm.nih.gov/books/NBK532271/) (StatPearls (NCBI Bookshelf), 2026); [Human Papillomavirus](https://www.ncbi.nlm.nih.gov/books/NBK448132/) (StatPearls (NCBI Bookshelf), 2026).

## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake

Representative model, for educational purposes only.

---
Source: https://durgical.com/en/general-pathology/benign-vulvar-lesions/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/general-pathology/benign-vulvar-lesions/