Differential Diagnosis for Vulvar Bumps

The patient presents with multiple, flesh-colored, painless, and non-itchy "bumps" in the vulvar area. Given her recent STI screening was negative and she hasn't had new sexual partners, the differential diagnosis can be organized as follows:

• Single Most Likely Diagnosis

  • Vulvar Vestibular Papillomatosis: This condition is characterized by multiple, small, flesh-colored papules on the vulvar vestibule. It is a benign condition and can be asymptomatic, which fits the patient's description of the bumps not hurting or itching. The desire to remove them due to aesthetic or sexual activity concerns is common.

• Other Likely Diagnoses

  • Fordyce Spots: These are small, yellowish or flesh-colored bumps on the vulva that represent ectopic sebaceous glands. They are benign and often asymptomatic, which aligns with the patient's symptoms.
  • Molluscum Contagiosum: Although the patient's recent STI screening was negative, molluscum contagiosum can be spread by non-sexual contact as well. It presents as small, flesh-colored, dome-shaped papules. However, they typically have a central umbilication, which was not mentioned.
  • Vulvar Cysts: These can present as bumps and are usually benign. They might be filled with fluid or semi-solid material and can be asymptomatic.

• Do Not Miss Diagnoses

  • Vulvar Intraepithelial Neoplasia (VIN): Although the patient had an abnormal Pap smear in the past that resolved, any vulvar lesion warrants consideration of VIN, especially given the history. VIN can present with a variety of symptoms, including visible lesions, and is a precursor to invasive cancer.
  • Squamous Cell Carcinoma: This is a type of skin cancer that can present as a bump or lesion. Given the patient's history of an abnormal Pap smear, although resolved, it's crucial not to miss any potential malignancy.

• Rare Diagnoses

  • Lymphangioma Circumscriptum: A rare condition characterized by multiple, small, vesicle-like lesions due to lymphatic malformations. It's usually present since birth or appears in childhood but can be considered in the differential for chronic conditions.
  • Vulvar Syringoma: These are rare, benign tumors of the eccrine sweat glands. They present as multiple, small, firm, yellowish or flesh-colored papules, typically on the vulva, and can be asymptomatic.

Each diagnosis should be considered in the context of the patient's full history, physical examination, and potentially further diagnostic testing such as biopsy for any suspicious lesions.