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Symptomatic HPV-related neovaginal lesions in transgender women: case series and review of literature
  1. Wouter B van der Sluis1,2,
  2. Marlon E Buncamper1,2,3,
  3. Mark-Bram Bouman1,2,3,
  4. E Andra Neefjes-Borst4,
  5. Daniëlle A M Heideman4,
  6. Renske D M Steenbergen4,
  7. Margriet G Mullender1,2,3
  1. 1Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, Amsterdam, The Netherlands
  2. 2EMGO+Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
  3. 3Centre of Expertise on Gender Dysphoria, VU University Medical Centre, Amsterdam, The Netherlands
  4. 4Department of Pathology, VU University Medical Centre, Amsterdam, The Netherlands
  1. Correspondence to Wouter B van der Sluis, Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, De Boelelaan 1117, Amsterdam 1081 HV, The Netherlands; w.vandersluis{at}


Objective Worldwide, transgender women are an at-risk population for contracting sexually transmitted infections. Little information exists on symptoms and characteristics of neovaginal human papillomavirus (HPV) infections and associated diseases. We describe a case series of transgender women with symptomatic HPV-related neovaginal lesions and a review of current literature.

Methods Transgender women with symptomatic HPV-related neovaginal lesions were identified from a departmental database comprising clinical and outpatient data on transgender women who underwent vaginoplasty between 1990 and 2015. HPV status was determined on excision and biopsy specimens by HPV DNA testing using GP5+6+-PCR and p16INK4A immunohistochemistry. Current literature was reviewed using the MEDLINE and EMBASE databases.

Results This case series includes four transgender women with symptomatic, HPV-related neovaginal lesions. Two women presented with neovaginal and neovulvar pain and condylomata/leukoplakia, which were excised. These lesions showed moderate-to-severe dysplasia at histopathological examination, and were positive for high-risk HPV (hrHPV) and p16INK4A. Recurrence occurred in one patient and was treated with laser evaporation. Two women presented with neovaginal coital pain, neovaginal bleeding and condylomata. Neovulvar lesions were treated with podophyllotoxin. Neovaginal lesions were excised or evaporated. These lesions were low-risk HPV (lrHPV) positive. The literature search shows treatment options varying from conservative, topical podophyllotoxin to excision or laser evaporation under general anaesthesia.

Conclusions Neovaginal HPV infection can lead to benign condylomata (lrHPV) and various grades of dysplasia (hrHPV). We advise physicians to consider HPV infection and associated lesions in transgender women with otherwise unexplainable neovaginal pain or bleeding after vaginoplasty.

  • HPV

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  • Handling editor Jackie A Cassell

  • Contributors WBvdS, MEBu and MGM designed the study. All authors contributed to acquisition, analysis or interpretation of data for the work. WBvdS wrote the first draft. All authors contributed to successive drafts and reviewed the final manuscript.

  • Competing interests None declared.

  • Ethics approval Medical Ethical Exam Committee (METC) VU University Medical Center.

  • Provenance and peer review Not commissioned; externally peer reviewed.