Vulval varicose veins affect the vulva, labia and perineum. For many women, they start in pregnancy and may either improve or get worse after they’ve had their babies.
In some women, the cause may be conditions that do not relate to pregnancy, such as blood clots (deep vein thrombosis (DVT), abnormal vessels or mechanical conditions that can cause compression of veins by surrounding structures, such as arteries. May-Thurner Syndrome is an example of this type of condition.
Until recently, exactly how blood flows within the pelvic veins has not been well understood. In particular, how the venous pelvis blood flow changes in pregnancy and how it goes back to normal, or not, after pregnancy.
Venous blood normally flows back to the heart in one direction from the leg veins. In the pelvis, blood can flow in different directions before returning to the heart. Pelvic blood flow like this can allow ‘escape points’ or detour routes between the pelvic veins and the veins of the labia and vulva, causing varicose veins in these areas. Often, they first occur in pregnancy and may also continue after giving birth.
Four percent of pregnancies get vulval varicose veins
As a result of the ‘escape points’ between the pelvic and vulval veins, about 4% of women will get vulval varicose veins when pregnant.
The pelvic veins can also communicate with veins in the legs. These include veins around the buttocks, the lower abdomen, and upper inner thigh area.
Ultrasound scanning is usually the first investigation for working out the cause of these veins. Sometimes transvaginal ultrasound will be useful in assessing the pelvic veins. Ultrasound scan will be performed standing or half standing, half sitting. CT and MR scans may also be very useful for diagnosis.
What are the Symptoms?
Vulval varicose veins cause aching, throbbing, heaviness, pressure and a feeling of fullness. Commonly, symptoms worsen with periods, exercise and on standing and sitting. Patients often describe the pain as dull, on one or both sides, with sharp flare-ups of pain. Pain with intercourse is common, too, often with discomfort afterwards.
As a general rule, women with labial varicose veins are younger, carry less weight and have less pelvic fat tissue. In addition, their babies are bigger than women who have typical varicose veins in the legs. Thoughts are that having less pelvic fat may allow pelvic organs to compress the pelvic veins more. Thus forcing venous blood through the ‘escape points’ between the pelvis and the vulva, labia, perineum, buttocks and legs.
And the Treatment Options?
The cause of the vulval varicose veins will define the treatment. If related to pregnancy, most will settle after delivery and no specific treatment is necessary. Varicose veins at the top of the thigh, which are linked to pregnancy vulval veins, require well-fitted compression stockings designed especially for pregnancy.
If the pain within the vulval varicose veins doesn’t go away on its own, treatment may be ultrasound-guided sclerotherapy. This is where injection of a vein irritant solution causes vein closure. Occasionally, a local anaesthetic day procedure called embolisation is necessary. This can block off the abnormal veins feeding the pelvic varicose veins. With the troublesome veins closed, improved blood flow out of the pelvis reduces the pressure and any symptoms within the pelvis.