What Causes Vaginal Skin Tags and Are They Serious?

Vaginal skin tags, more accurately called vulvar skin tags, are small benign growths of skin and fibrous tissue that develop on or near the external genital area. They are overwhelmingly harmless. Formed from the same type of tissue as skin tags elsewhere on the body, they share the same basic causes: friction, hormonal shifts, and metabolic factors like insulin resistance. The reason they attract more worry than a skin tag on the neck or armpit is their location, which makes people fear they might be warts, a sexually transmitted infection, or something worse.

Vulvar, Not Vaginal

Most people who search for “vaginal skin tags” are actually describing growths on the vulva, the external structures that include the labia majora, labia minora, and the area around the vaginal opening. True vaginal skin tags, inside the vaginal canal, are rare and usually discovered during a pelvic exam rather than by the person themselves. The distinction matters because the vulva is skin-covered and subject to the same dermatological conditions as any other skin surface, while the vaginal canal is a mucosal environment with a different set of conditions. Throughout this article, “vulvar skin tag” refers to growths on the external genitalia, which is what most people mean.

What a Vulvar Skin Tag Is Made Of

A skin tag, known in medical language as an acrochordon or fibroepithelial polyp, is a small outgrowth of normal tissue. Under a microscope, a typical vulvar skin tag shows a core of loose fibrous tissue with elongated blood vessels, all covered by a layer of ordinary squamous epithelium, the same type of skin that covers the rest of the vulvar surface.¹ There is nothing structurally abnormal about the tissue itself. It is simply normal skin and connective tissue that has grown outward into a small stalk or flap, typically between a few millimeters and a centimeter across, though occasionally larger.

These growths are soft, flesh-colored or slightly darker than the surrounding skin, and usually painless. They may hang from a thin stalk (pedunculated) or sit on a broader base. Most are discovered incidentally during bathing or grooming and cause no symptoms at all.

Why They Form

Skin tags develop in areas where skin rubs against itself or against clothing, which is why the vulvar region, groin folds, neck, and armpits are the most common sites. The vulva is particularly prone because of the combination of warmth, moisture, and constant low-grade friction from underwear, exercise, and daily movement. One case study documented skin tags arranged in a linear pattern directly along a line of friction, supporting friction as a direct trigger for their formation.²

But friction alone does not explain why some people develop them and others do not. Several other factors play a role:

Insulin resistance: Elevated insulin levels stimulate the growth of both skin cells and the fibrous tissue underneath them. Studies have found that skin tags are directly associated with insulin resistance markers, independent of whether someone has been diagnosed with diabetes.³ In one study, people with high insulin resistance scores were roughly seven and a half times more likely to have skin tags than those with normal scores.³
Obesity and metabolic syndrome: Higher body mass index and elevated triglycerides are independently associated with skin tag development, overlapping significantly with the insulin resistance pathway.⁴
Hormonal changes: Vulvar skin tags are described as hormone-responsive lesions and are most commonly found in females of reproductive age.⁵ Estrogen and progesterone fluctuations during puberty, pregnancy, and perimenopause appear to contribute to their development.
Age: Skin tags become more common with age, particularly after the thirties and forties, as skin loses elasticity and metabolic factors accumulate.

The underlying mechanism researchers point to involves insulin-like growth factor receptors. When insulin levels are chronically high, these receptors get activated more aggressively, driving proliferation of both the surface skin cells and the deeper fibrous tissue that make up a skin tag.⁴

Pregnancy and Vulvar Skin Tags

Pregnancy is one of the most common triggers for new or rapidly growing vulvar skin tags. The combination of surging hormones, increased blood volume, weight gain, and greater friction in the groin area creates a perfect environment for their development. Some women notice small tags appearing for the first time during the second or third trimester, and existing ones may enlarge. A case report documented a giant vulvar skin tag presenting during the second trimester, illustrating how dramatically hormonal responsiveness can drive growth in this tissue.⁵

For most pregnant women, these tags are nothing more than a cosmetic nuisance. Some shrink after delivery as hormone levels normalize, though they rarely disappear entirely on their own. Removal during pregnancy is generally deferred unless a tag is causing significant pain or bleeding, since the area heals more slowly during pregnancy and the tag may recur while hormonal stimulation continues.

The HPV Question

One piece of research that often alarms people when they encounter it is a study that detected human papillomavirus DNA in a high percentage of skin tags. That study found HPV type 6/11 DNA in 88% of the skin tags examined, leading the researchers to suggest HPV may play a role in the development of these growths.⁶

Before that number sends you into a spiral, some context helps. HPV types 6 and 11 are the low-risk strains associated with benign conditions like common warts and genital warts, not the high-risk strains linked to cervical or vulvar cancer. The finding also has not been consistently replicated across all studies, and the presence of viral DNA in a tissue sample does not prove the virus caused the growth. It may simply mean HPV was present in the surrounding skin and ended up incorporated into the growing tag. The medical consensus still classifies skin tags as benign proliferations driven primarily by mechanical and metabolic factors rather than as viral lesions. If you have a skin tag, it does not mean you have an HPV infection that needs treatment.

When They Cause Problems

Most vulvar skin tags are discovered by chance and never cause any symptoms. They sit quietly on the skin surface for years, neither growing nor changing. Trouble starts in a few specific scenarios:

Size: Larger tags can catch on underwear, get pinched during exercise, or chafe against the inner thigh. The resulting irritation can cause soreness and even minor bleeding.
Twisting: A skin tag on a narrow stalk can twist on itself (torsion), cutting off its own blood supply. This is painful and the tag may become swollen, darkened, or inflamed.
Secondary infection: A tag that has been irritated or partially torn can become a site for bacterial infection, leading to redness, warmth, and discharge.
Psychological distress: Because of their location, vulvar skin tags cause significant anxiety for some people, who may worry they have a sexually transmitted infection or cancer. The cosmetic and emotional burden should not be dismissed.

Giant vulvar skin tags, while rare, can mimic the appearance of a tumor and create genuine diagnostic confusion for both the patient and the clinician, sometimes leading to unnecessary alarm until pathology confirms the tissue is benign.⁷

What Else It Could Be

The reason clinicians take vulvar lumps and bumps seriously, even when they strongly suspect a benign skin tag, is the list of conditions that can mimic one. In the genital region, the differential diagnosis includes genital warts (condylomata acuminata), squamous cell carcinoma, basal cell carcinoma, neurofibroma, and a rare premalignant growth called a Pinkus tumor.⁸ In very rare cases, squamous cell carcinoma has been reported arising from what initially appeared to be a skin tag.⁸

This does not mean your skin tag is cancer. The overwhelming majority are exactly what they appear to be. But it does mean that a new, growing, bleeding, or unusual-looking vulvar growth deserves a professional evaluation rather than a Google diagnosis. A clinician familiar with vulvar dermatology can usually distinguish a skin tag from a wart or a more concerning lesion on visual inspection alone. When there is any doubt, a biopsy settles the question definitively. Histopathological examination of excised vulvar skin tags routinely confirms benign tissue with no evidence of malignancy.⁹

Vestibular Papillomatosis, the Common Lookalike

One condition that is frequently confused with both skin tags and genital warts is vestibular papillomatosis. These are tiny, soft, finger-like projections found on the inner labia minora and around the vaginal opening. They are the same color as the surrounding mucosa and arranged symmetrically or in rows. Estimates of how common they are vary widely, with studies reporting them in anywhere from about 1% to 33% of healthy young women.¹⁰

Vestibular papillomatosis is considered a normal anatomical variant, not a disease. It has no association with HPV or any sexually transmitted infection. The key distinguishing feature is that each individual papilla has its own separate base, while wart-like lesions tend to have projections that fuse together at the base. Another clinical test involves applying dilute acetic acid: warts will turn white, while vestibular papillae remain unchanged.¹⁰ Despite being harmless, vestibular papillomatosis has historically been misdiagnosed as condylomata and unnecessarily treated, causing patients avoidable distress and sometimes painful procedures for a condition that needs no intervention.

If you are unsure whether what you are seeing is a skin tag, vestibular papillomatosis, or something else, that uncertainty is itself a reason to see a clinician. The three conditions look different to a trained eye, and the management is different for each.

Removal Options

No medical guideline recommends removing asymptomatic vulvar skin tags. If a tag is not causing pain, bleeding, or distress, leaving it alone is a perfectly reasonable choice. Skin tags do not transform into cancer and do not grow indefinitely.

When removal is desired, it is straightforward. Most vulvar skin tags can be excised in an office setting under local anesthesia. One published case report describes a large vulvar skin tag being successfully removed in a primary care office, demonstrating that referral to a specialist is not always necessary.¹¹ The excised tissue is typically sent for pathology as a precaution, confirming its benign nature and ruling out any unexpected findings.

Common removal methods include simple surgical excision with scissors or a scalpel, cryotherapy (freezing), and electrocautery (burning). The choice depends on the tag’s size, its stalk width, and the clinician’s preference. The vulvar area tends to heal well due to its rich blood supply, though the location can make the first few days after removal uncomfortable. Standard wound care applies: keeping the area clean and dry, avoiding tight clothing, and watching for signs of infection.

One thing to be aware of is that removal does not prevent new tags from forming. If the underlying factors that caused the first tag are still present, whether that is ongoing friction, insulin resistance, or hormonal influence, new skin tags may develop nearby. Addressing the root metabolic drivers, such as improving insulin sensitivity through diet and exercise, may reduce the likelihood of recurrence, though no clinical trial has tested this specifically for vulvar skin tags.

When a Biopsy Is Warranted

Not every vulvar skin tag needs a biopsy. A small, soft, flesh-colored tag on a thin stalk in a young woman is almost certainly benign and can be diagnosed clinically. But certain features should prompt a clinician to obtain a tissue sample rather than simply snipping and discarding. These include rapid growth, unusual pigmentation, irregular or hard texture, ulceration, bleeding without trauma, or any atypical vascular patterns visible on the surface. A biopsy is also appropriate when the growth has not responded to standard treatment, when there is suspicion of an autoimmune or systemic condition, or when the patient requests removal for functional or cosmetic reasons and pathological confirmation is prudent.

The biopsy itself is a minor procedure. A small piece of tissue, or the entire lesion, is removed under local anesthesia and sent to a pathologist. Results typically come back within a week or two. For the vast majority of vulvar skin tags, the pathology report confirms a benign fibroepithelial polyp and that is the end of the story.

Skin Tags as a Metabolic Signal

One underappreciated aspect of skin tags anywhere on the body, including the vulvar area, is what they can signal about your metabolic health. The strong association between skin tags and insulin resistance means that a sudden crop of new skin tags, or existing tags that are multiplying, may be worth mentioning to your doctor even if the tags themselves do not bother you. This is especially true if you also have other features of metabolic syndrome, such as central obesity, high blood pressure, or abnormal cholesterol levels.

The link between skin tags and insulin resistance holds even after adjusting for diabetes diagnosis, age, sex, and body weight.³ In other words, you do not need to be overweight or diabetic for the association to apply. Chronically elevated insulin, stimulating growth factor receptors in the skin, can produce these lesions in people whose blood sugar levels still test normal. Some dermatologists consider the presence of multiple skin tags a soft clinical marker that warrants screening for insulin resistance and prediabetes, though this is a clinical judgment call rather than a formal guideline.

This framing recontextualizes vulvar skin tags in a useful way. Rather than viewing them purely as a cosmetic or anatomical nuisance, they can serve as a visible prompt to check in on metabolic health, particularly for women in their thirties and forties who may not have had recent bloodwork. The skin tag itself is harmless. What it hints at underneath may be worth investigating.

1
PubMed Central. Unveiling the Truth: Fibroepithelial Polyp of the Vulva and Its Misdiagnosis as Cancer – Section: Case presentation
2
PubMed. Friction induced skin tags
3
PubMed. Association between skin tags and insulin resistance
4
PubMed Central. A Clinical Evaluation of Skin Tags in Relation to Obesity, Type 2 Diabetes Mellitus, Age, and Sex – Section: Discussion
5
BMJ Case Reports. Giant vulvar acrochordon (skin tag) presenting in second trimester of pregnancy
6
PubMed. The detection of human papillomavirus DNA in skin tags
7
PubMed Central. Unveiling the Truth: Fibroepithelial Polyp of the Vulva and Its Misdiagnosis as Cancer
8
Open Journal of Obstetrics and Gynecology. Unusually Large Skin Tag of Labium Majus – Section: Discussion
9
Canadian Family Physician. Large vulvar skin tag removed in a primary care office setting – Section: Investigation
10
PubMed. Vulvar vestibular papillomatosis – Section: Discussion
11
Canadian Family Physician. Large vulvar skin tag removed in a primary care office setting