Perineal Papules in a 30-Year-Old Woman

Case at a Glance

A 30-year-old woman presents with newly discovered perineal papules, causing concern about sexually transmitted infections despite negative screening history.

Patient's Story

The patient is a 30-year-old woman in a monogamous relationship for 2 years who noticed small bumps on her perineum that appeared 1-2 weeks prior to presentation. She initially attributed the lesions to mechanical irritation from sexual activity, describing a sensation of skin splitting at the vaginal opening. The patient reports no pain or discomfort from the lesions themselves. Her partner noticed the bumps during intimacy and expressed concern about possible STI transmission, causing relationship strain and patient anxiety.

Initial Assessment

Patient has a history of regular gynecological care with consistently normal Pap smears and negative STI screenings prior to her current relationship. She maintains she has been monogamous for 2 years. Physical examination reveals multiple small, flesh-colored papules on the perineum. The lesions appear benign without signs of ulceration, inflammation, or discharge.

The Diagnostic Journey

Initial clinical impression suggested possible Fordyce spots based on appearance and distribution. The patient mentioned the possibility of pregnancy, wondering if hormonal changes could be contributing to the lesions. Recent STI testing was reportedly negative, helping to rule out infectious etiologies. The benign appearance of the lesions and lack of associated symptoms supported a diagnosis of normal anatomical variants rather than pathological lesions.

Final Diagnosis

Fordyce spots (ectopic sebaceous glands) of the perineum, likely related to hormonal changes possibly associated with early pregnancy.

Treatment Plan

Patient counseling regarding the benign nature of Fordyce spots and their common occurrence, especially with hormonal fluctuations. Education provided about normal anatomical variants to reduce anxiety. Recommendation for pregnancy testing given patient's suspicion. Partner education recommended to address relationship concerns and prevent further accusations.

Outcome and Follow-up

Patient was reassured about the benign nature of the lesions. Follow-up planned for routine gynecological care with instructions to return if lesions change in appearance, become symptomatic, or if pregnancy is confirmed for appropriate prenatal care initiation.