Genital Warts in Women – What Any Woman Must Know About HPV

Sadly, women get the worst of what human papillomavirus (HPV) infection has to offer. The rate of HPV infection among American women is staggering: As many as 75% of women in the United States have been infected or will be infected with HPV (aside from those receiving the HPV vaccine—more on that later).

What is worse is that several of the over 80 identified types of human papillomavirus can cause serious diseases in women including genital warts, cervical cancers, and cancers of vulva, vagina, urethra, and anus. Because sexually active, heterosexual women primarily engage in receptive intercourse (oral, anal, and vaginal) their risk for contracting these diseases is higher than it is in men.

Genital warts in women can appear in many different forms and in many different locations. In general, genital warts are flesh-colored and elevated slightly above the surface of the skin. They can also be white, gray, pink, or slightly purple and flat or shaped like the head of a cauliflower. They can occur anywhere on the surface of the body, even the hands and feet, though these locations are uncommon sites for genital warts. Genital warts in women appear most often:

• Around the vagina
• On the vulva
• Inside the vagina
• On or around the cervix
• In the mouth and/or throat
• Between the vagina and the anus
• In the folds between the legs and the genitals
• On and around the anal sphincter
• Within the anus itself

While women can get genital warts on and around the anal sphincter, it is extremely uncommon for them to occur inside the anus without the person having engaged in receptive anal intercourse with an infected person. The same holds true for genital warts within the vagina; they are rare unless the woman engages in receptive vaginal intercourse with an infected partner.

It is quite possible to have genital warts that cause no symptoms whatsoever. If they do cause symptoms, the symptoms are usually pain, tenderness and itchiness around the genital wart. genital warts may bleed or discharge a liquid. When they occur inside the vagina, genital warts may cause bleeding or discharge that is not associated with menstruation or ovulation. If they become quite large it is possible that the genital warts obstruct urine flow, obstruct the flow of stool, or make intercourse too painful or physically impossible (these occur very rarely).

Protection against HPV infection is a reasonable first goal when it comes to genital warts in women. Women and girls between the ages of 9 and 26 are eligible to receive a vaccine that provides immunity and protection against the four main types of HPV that most commonly cause serious diseases: HPV types 6, 11, 16, and 18. These four types cause the majority of genital warts and cervical cancers. The vaccination takes place over six months and three separate injections are required; however, once the immune system has been fully immunized, the transmission rate of these four types of human papillomavirus decreases dramatically.

If you do not fall within this age range or you have decided with your doctor that the HPV vaccine is not right for you, you can still take steps to improve your chances of staying free of infection. While they are not 100 percent effective at blocking HPV transmission, barrier protection (either male or female condoms) can reduce the risk somewhat. Moreover, you should avoid having sexual intercourse of any kind with a partner that has suspicious genital lesions until they have been examined by a doctor and treated. Since genital warts contain high amounts of human papillomavirus and that this virus gains access to others through breaks in the skin and mucous membranes, limiting exposure reduces HPV infection.

There is no complete cure once genital warts do occur but there are several treatment options that can eliminate the appearance of the warts and reduce the chance of infecting others with HPV. Often the procedures that destroy the genital warts are the most effective. These include cryotherapy (freezing the genital warts), electrosurgery (cutting and cauterizing the warts with an instrument that provides electrical cutting ability), and acid ablation (burning the genital wart with trichloroacetic acid, for example). Medical therapy includes podophyllum resin, interferon alfa-2b (Intron A), 5-fluorouracil, podofilox , imiquimod (Aldara) and Veregen.

Some creams and local injections can be helpful as well though special care must be taken with these treatments when there is a chance of pregnancy. In fact, trichloroacetic acid or TCA is usually the treatment of choice for genital warts in women of childbearing age. The genital warts may be burnt and destroyed using a laser as this poses little threat to the fetus.
Genital warts that occur inside the anus or vagina are particularly challenging for women. Not only may they cause symptoms during bowel movements or sexual intercourse, but they also increase the risk of infection to sexual partners because of their location. Moreover, they are difficult to treat because many of the existing genital wart treatments are intended to treat external warts.

For genital warts inside the vagina or anus, it may be perfectly reasonable to wait to see if they heal on their own—a course of action known as “watchful waiting.” This may be the best course of action during periods of sexual abstinence or when the warts are not causing distressing symptoms. When active treatment is desired, cryotherapy is the treatment of choice for internal lesions. Trichloroacetic acid (TCA) and laser ablation are also possible treatment options for internal genital warts.

An alternative treatment for vaginal warts that is not currently used very often is 5-FU or 5-fluorouracil. This is a chemotherapeutic agent that can be infused deep within the vagina and will destroy HPV-infected cells. If this approach is used, the areas without warts should be protected with petroleum jelly and a tampon may be kept in place to prevent leakage. Even though the drug stays mostly within the region close to the vagina, this risk of potentially serious side effects makes 5-FU use a less attractive option than others.