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Vulvar varicosity, sometimes referred to as vaginal varicose veins or varicose veins in the vulva are common in 10% of pregnant women. Occasionally symptoms present in women who have never been pregnant. The lack of attention to this disorder is typically due a reluctance by women to discuss this extremely personal concern and due to the limited number of vein specialists with experience in this area...Until Now!
Vulvar varicosities are enlarged veins that most likely develop from a combination of valvular incompetence and proximal venous obstruction, that results in increased venous pressure. The vascular drainage of the female external genitalia is comprised of the dorsal superficial clitoral, bulbovestibular, profundus clitoral, and posterior labial veins. Perineal veins do not have valves and are therefore predisposed to the development of varices (varicose veins). Up to 50% of vulvar varicose veins arise from an incompetent great saphenous vein, which normally drains the superficial and deep external pudendal veins and posteromedial tributaries.
Venous insufficiency of the ovarian veins and internal iliac may also contribute to progression of varicose veins over the territories of their main branches (ie, the internal pudendal and obturator veins). These varices can be large, have frequent anastomoses (connection of normally separate veins), and involve the vulva and middle of the back side of your thigh.
Vulvar varicosities are most common in pregnant women because physiologic and anatomic changes related with pregnancy result in pelvic venous congestion. It is believed that these include (a.) increased pelvic blood flow, which impairs venous return via the femoral veins and thus contributes to venous congestion in the legs and pelvis, and (b.) mechanical compression of the inferior vena cava/iliac veins by the pregnant uterus, which increases venous pressure distally.
In addition, hormonal changes likely contribute by causing the enlargement of blood vessels (vasodilation). An increase in estrogen and progesterone and the weight of a new baby typically contribute to underlying venous insufficiency, and the symptoms of varicose veins in the legs and vaginal area. With every additional pregnancy, symptoms typically occur earlier and become more significant. In non-pregnant women, they normally present in your 20’s or 30’s.
Vaginal Varicose Veins Signs and Symptoms
Sometimes vulvar varicose veins symptoms are visual and you will see dark, swollen veins that may resemble earthworms, and these often do not present painful symptoms. Symptomatic women describe:
The cause of vaginal varicose veins is typically an increase in the volume of blood circulating in the body during pregnancy, increased weight and pressure from the baby, and hormones released during pregnancy which weaken the vein walls. These causes, in addition to underlying Chronic Venous Insufficiency (the cause of varicose veins in the legs) will almost always result in the development of varicose veins near the external genital organs, the labia.
IMPORTANT - Vein treatment of any kind cannot be performed until after giving birth, however the symptoms can be addressed.
The following items are found to be the most effective at temporary relief of symptoms:
You most likely will not need treatment for vulvar varicose veins as improvement in the appearance of vaginal varicose veins is typically seen within 4-8 weeks post-partum. Sometimes symptoms will ease as well, but if this is not the case for you, veins can be treated based upon the underlying cause. It is important to evaluate for venous insufficiency and Pelvic Congestion Syndrome before attempting any treatment as these are often the major underlying cause.
Once a duplex ultrasound has ruled out venous insufficiency, sclerotherapy is the preferred treatment. If venous insufficiency is present, sclerotherapy can still be utilized as adjunct treatment while the leg veins are treated.
At Advanced Vein Institute of Arizona, we believe that every patient is unique, and every vein treatment needs to be specifically tailored for each patient. A full exam, Duplex Ultrasound, and if needed a Transvaginal Ultrasound will enable us to properly diagnose and recommend treatment, based on your specific needs.
"Dr. Jilanne Rose, ANP-C has treated several of our mutual patients for the common and bothersome condition of vulvar varicosities (varicose veins of the vulva or vagina). Each of these patients has been very pleased with their results. They are happy to be pain-free and are glad they found treatment for this condition.
As part of her evaluation, Jilanne performs a clinical examination and a transvaginal ultrasound scan. She also performs a duplex ultrasound of both legs. This way, she can assess the full extent of the condition, as often varicosities are present in both the vulvar region and in the legs. After the full evaluation, Jilanne will determine if the condition is best treated with custom compression legwear or with a minimally invasive in-office procedure."
Randall Craig, MD
Board Certified Reproductive Endocrinologist & Infertility and OB/GYN