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Genital warts in women are soft growths on the vulva, vaginal opening, vaginal walls, cervix or around the anus, caused by the human papillomavirus. They are extremely common, they are treatable, and their management carries one additional dimension that does not apply in men: because HPV is also the cause of cervical cancer, a woman diagnosed with genital warts should have proper cervical screening as part of her care.
HPV infects the skin and mucosa through microscopic breaks during sexual contact. Low-risk types 6 and 11 cause the visible cauliflower-like warts. High-risk types, principally 16 and 18, rarely cause warts but cause the cellular changes that can progress to cervical cancer over many years. The two can be present together, which is why the visible warts are treated and the cervix is screened.
1. Skin-to-skin sexual contact; condoms reduce but do not eliminate risk
2. Multiple or new sexual partners
3. Early age at first intercourse
4. Smoking, which impairs local immune clearance of HPV
5. Reduced immunity from diabetes, HIV, pregnancy or immunosuppressive medication
6. An incubation period of weeks to months, so the timing rarely identifies the source
1. Small flesh-coloured or greyish lumps on the vulva or around the anus
2. Clusters with a rough, cauliflower-like surface
3. Itching, burning or discomfort during intercourse
4. Bleeding after intercourse if warts are on the cervix or vaginal wall
5. Increased vaginal discharge
6. Rapid enlargement during pregnancy, when immunity and blood flow both change
7. Frequently no symptoms at all, with internal warts found only on speculum examination
See a gynaecologist as soon as you notice any growth in the genital area. Never use wart paints intended for hands and feet, which cause severe burns on genital skin. A full speculum examination is essential, since warts inside the vagina and on the cervix cannot be seen or self-treated and are a common source of recurrence. Any lesion that bleeds, ulcerates or is unusually pigmented should be biopsied.
1. Laser ablation: Precise, bloodless clearance of external and internal warts in a single daycare session, with excellent healing and minimal scarring.
2. Topical immunotherapy: Imiquimod or podophyllotoxin for small external lesions, under supervision. These are not used in pregnancy.
3. Cryotherapy or electrocautery: Suitable alternatives for limited external disease, and cryotherapy is safe in pregnancy.
4. Cervical screening: Pap smear with HPV co-testing, and colposcopy where indicated. This is the part that must not be skipped.
5. HPV vaccination: Protects against types not yet acquired and reduces recurrence.
6. Partner evaluation and STI screening, with treatment of any co-existing infection.
Visible warts multiply and spread into the vagina and anal canal, becoming much harder to clear and more prone to recurrence. In pregnancy they can enlarge dramatically, occasionally enough to obstruct delivery. But the more important consequence of delay is the missed screening opportunity: persistent high-risk HPV progresses silently through precancerous cervical changes over several years, and those changes are almost entirely curable when detected on a routine Pap smear and almost entirely preventable with vaccination. Treating the warts and screening the cervix together is what makes the difference.

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