Genital warts are soft growths that appear on the genitals, though they may also appear on the lips, mouth tongue or throat. In men, they can appear on the scrotum, penis, groin area, thighs as well as in or around the anus. In women, they can appear in or around the vagina, in or around the anus, or on the cervix.
These growths, which are similar in appearance to warts, are symptoms of the human papillomavirus (HPV infection). 
What are the risks of HPV infection?
Genital warts may cause itching, a burning sensation, or bleeding. In women, they may also cause vaginal discharge. Though these genital warts are typically asymptomatic, their appearance may cause disfigurement of the genital and anal regions.
Another thing to know is that HPV infection is the main cause of cervical cancer. HPV infection is also associated with head and neck cancer (especially oral cavity cancers), anal cancer, cancer of the vulva, and penile cancer.
Your doctor may recommend a biopsy of genital warts if he or she is uncertain about your condition. Also, the biopsy can determine the possibility of associated cancer.
What is a biopsy of genital warts?
A biopsy is a procedure wherein a piece of tissue or a sample of cells are removed from the body so that they can be tested in a laboratory. For suspected HPV, a microscopic exam can help your doctor find out the cause and characteristics of a wart. In this exam, your doctor will remove a suspected wart or shave off samples from a large suspected wart.
The majority of warts do not require a biopsy, but a biopsy may be taken if genital warts cannot be easily identified with a physical exam or during a gynecology exam with a lighted magnifying instrument (colposcopy). A biopsy can also rule out associated cancer.
Why is a biopsy performed?
You may have a biopsy if any of the following are true:
- Your doctor is not sure what type of abnormal tissue is present.
- Warts have not responded to treatment.
- Warts appear unusual. (These warts may harbor cancer.)
What should I know before a biopsy of genital warts?
Treatment for genital warts includes watchful waiting without treatment, medical treatment, or removal of the abnormal tissue. The decision to do a biopsy will be based on whether biopsy results are likely to affect treatment. If a biopsy confirms male genital, vaginal, or perianal warts, medical treatment is an option. It’s also a good idea to avoid sexual intercourse until the biopsy area is healed.
The biopsy will be done in your doctor’s office or clinic. During this procedure, you may receive an injection of a numbing medicine (local anesthetic).
What happens during the biopsy?
A small sample of tissue (biopsy) may be taken from the genital warts. Then the sample is examined under a microscope. Biopsies of the outer genital area on both men and women are more likely. This includes the vulva, scrotum, or penis.
While the injection that delivers the anesthetic can be painful, the biopsy is otherwise painless. Local anesthetic is used when the procedure is likely to be more painful than the injection, but the patient will not feel it thanks to the anesthetic.
What happens after?
Women who have a biopsy may feel some soreness in the vagina for a day or two. Some vaginal bleeding or discharge is normal for up to a week after a biopsy. In case this occurs, you can use a sanitary pad for the bleeding. Do not douche, have sex, or use menstrual cups or tampons for one week, to allow time for your cervix to heal.
If a colposcopy was performed, do not exercise for a day.
If you have any questions, please consult with your doctor to better understand your instructions.
