Deceptive vulvar papillomavirus infection. A possible explanation for certain cases of vulvodynia.

Use of the colposcope for vulvar and vaginal examination in four cases of long-standing vulvodynia led to the identification of lesions with an unusual appearance. In the vulvar vestibule, epithelial projections resembling cactus, camel humps or stony colonial pavement were observed. In the vagina, the lesions looked more like cerebral folds. Biopsies of these lesions showed histopathologic changes diagnostic of human papillomavirus infection, scored according to Reid's criteria. In one case, capsid antigen was detected with the peroxidase technique in the nuclei of the superficial cells. Past history and positive findings in the sexual partners of some of the patients suggested long-standing herpesvirus activity in the lower genital tract. In some cases of recalcitrant vulvodynia, colposcopic examination of the vulva and vagina may lead to a viral explanation for symptoms previously considered psychosomatic in origin.