Patients may complain of perineal itching, burning, pain, and tenderness, although they are commonly asymptomatic, especially with cervical and vaginal involvement. Distinctive fleshy warts can be found on the external genitalia or anus (Figs. 87.1 and 87.2). Lesions are pedunculated or broad-based with pink to gray soft excrescences, with multiple papillae arising from a single base. They occur in clusters or individually and can become friable. In addition to the external genitalia (i.e., the penis, vulva, scrotum, perineum, and perianal skin), genital warts can occur on the uterine cervix as well as in and around the vagina, urethra, anus, and mouth.