**Question:** A 28-year-old woman presents to her family physician complaining that she has a "growth" in her genital area. She states that she first noticed it 3 weeks ago and it seems to have grown somewhat since that time. She has hypothyroidism, for which she takes thyroid hormone replacement. She has no other medical problems and has never had surgery. She has had 3 sexual partners over her lifetime and is currently involved in a monogamous relationship. She has never had a sexually transmitted disease in the past. Examination demonstrates two non-tender, 6 mm, well-circumscribed, flesh-colored, papillated, oval lesions on the labia majora. There is no ulceration, erythema, purulence, or inguinal lymphadenopathy. Which of the following is the most likely diagnosis?

A. Genital warts
B. Condyloma acuminatum
C. Squamous cell carcinoma
D. Fibroepithelial polyp

**Core Concept:**

The presented case describes a patient with a history of hypothyroidism, which is treated with thyroid hormone replacement therapy. Among the options given, we need to consider the following aspects:

1. Genital warts (HPV infection)
2. Condyloma acuminatum (HPV infection)
3. Squamous cell carcinoma (epithelial malignancy)
4. Fibroepithelial polyp (benign fibromuscular growth)

**Why the Correct Answer is D:**

The correct answer is D: Fibroepithelial polyp. Fibroepithelial polyps are benign fibromuscular growths that can arise from the stratified squamous epithelium of the female genital tract. They are more commonly found in women over 40 years of age, but can occur in younger women as well. The patient's age (28 years) and absence of risk factors like multiple sexual partners, HPV infection, or malignancy make C (squamous cell carcinoma) and B (condyloma acuminatum) unlikely.

**Why Other Options are Incorrect:**

A) Genital warts (HPV infection) and B) Condyloma acuminatum (HPV infection) are not the correct answers because:

- HPV infection is more common in younger individuals, especially those with multiple sexual partners or HPV-related sexual contact.
- The patient has only had 3 sexual partners and is in a monogamous relationship, making HPV infection less likely.

C) Squamous cell carcinoma is an epithelial malignancy that would not present as a small, non-ulcerated, painless growth. The patient's age (28 years) and lack of risk factors (HPV infection or multiple sexual partners) make C (squamous cell carcinoma) unlikely.

E) Fibroepithelial polyp (D) is the correct answer.

**Clinical Pearls:**

1. Fibroepithelial polyps are more common in postmenopausal women but can occur in younger women too.
2. Fibroepithelial polyps are usually asymptomatic but may present with