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 aligns with the patient's symptoms. 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 but can be noticed during intimate activities or self-examination.
  • Molluscum Contagiosum: Although the patient's recent STI screening was negative, molluscum contagiosum is a viral infection that can cause small, flesh-colored, dome-shaped bumps. It's contagious and can be spread by skin-to-skin contact, but it doesn't always imply a new sexual partner if the incubation period is considered.
• Do Not Miss Diagnoses
  • Vulvar Intraepithelial Neoplasia (VIN): While the patient has a history of an abnormal Pap smear that resolved, any vulvar lesion should prompt consideration of VIN, especially if there are areas of pigmentation, ulceration, or if the lesions are fixed and hard. VIN can be a precursor to invasive cancer.
  • Squamous Cell Carcinoma: Although rare in a 28-year-old, any persistent or changing vulvar lesion should be evaluated for malignancy, especially with a history of abnormal Pap smears.
• Rare Diagnoses
  • Lichen Sclerosus: This is a chronic inflammatory skin condition that can cause white, patchy skin that's thinner than normal. While it can present with itching and pain, some cases might be asymptomatic. It's less likely given the description of flesh-colored bumps but should be considered if other symptoms or signs are present upon examination.
  • Neurofibromas: These are rare, benign tumors of the nerve tissue. They can appear as soft, fleshy growths on the skin and are associated with neurofibromatosis type 1 (NF1). The presence of multiple neurofibromas, especially in the vulvar area, would be unusual and might suggest an underlying condition like NF1.

Each diagnosis should be considered in the context of a thorough medical history, physical examination, and potentially diagnostic procedures such as biopsy for any suspicious lesions. The patient's desire for removal due to aesthetic or sexual activity concerns should be addressed while ensuring any underlying condition is properly evaluated and managed.