Is Genital Molluscum Painful?
Genital molluscum contagiosum is typically not painful—the lesions are characteristically asymptomatic, though they may occasionally present with itching, redness, or pain, particularly if complicated by bacterial superinfection or inflammation. 1
Primary Clinical Presentation
Molluscum contagiosum presents as skin-colored, whitish, or pink papules (2-5 mm diameter) with a shiny surface and characteristic central umbilication that are mostly asymptomatic 1, 2
The lesions are described as firm, rounded papules that remain stable over weeks to months without the rapid progression seen in other genital infections 3, 4
In the genital region of sexually active adults, these lesions are typically painless and discovered incidentally or due to cosmetic concerns rather than discomfort 2, 5
When Pain May Occur
Pain can develop as a secondary complication when lesions become inflamed, develop bacterial superinfection, or are associated with eczematous changes 1, 4
Itching is more common than pain and may lead to scratching, which can result in inflammation or secondary infection that then becomes painful 4
Treatment-related pain occurs with physical removal methods (curettage, cryotherapy, cautery) rather than from the lesions themselves 6, 7, 2
Critical Diagnostic Distinction
If genital lesions are painful, consider alternative diagnoses, particularly herpes simplex virus, which presents with painful grouped vesicles on an erythematous base that rapidly progress to shallow ulcers 3
Herpes lesions follow a predictable painful progression (erythema → papules → vesicles → ulcers → crusts) within less than 10 days, contrasting sharply with the stable, painless papules of molluscum that persist for months 3
Laboratory confirmation should always be sought for painful genital ulcerative or vesicular lesions, as HSV is the most common cause of sexually acquired genital ulceration and clinical diagnosis alone is unreliable 3
Clinical Pitfalls to Avoid
Do not assume all painless genital papules are molluscum—screening for other sexually transmitted infections is recommended in patients with genital molluscum contagiosum 2, 5
The presence of pain should prompt immediate consideration of herpes simplex, bacterial superinfection, or other diagnoses rather than typical molluscum 3, 4
In immunocompromised patients, multiple large molluscum lesions with relatively little inflammation may be present, but these remain characteristically painless unless complicated 6, 2