Varicose veins of the intimate area - an embarrassing problem

Varicose veins of the intimate area are a subject that is still very little talked about. Women who suffer from them often do not know which doctor to go to, and when they do go to the gynaecologist, they usually find out that nothing is being done about it. This is a frequent comment from our patients who come to the Phlebology Clinic in Warsaw, comments Dr Cezary Szary, a radiologist and phlebologist who treats pelvic venous insufficiency.

Varicose veins of the intimate area are a subject that is still very little talked about. Women who suffer from it often do not know which doctor to go to, and when they do go to the gynaecologist, they are usually told that nothing is being done about it. This is a frequent comment from our patients who come to the Phlebology Clinic in Warsaw - comments Dr Cezary Szary, radiologist and phlebologist dealing with the treatment of pelvic venous insufficiency. How do these types of varicose veins develop, how are they diagnosed and what is their treatment? A few words about this below.

Varicose veins of the intimate area - when and where do they form?

Women between the ages of 20 and 45 are most often at risk of developing varicose veins of the intimate area during their second and subsequent pregnancies. Varicose veins can also appear after childbirth, when the phenomenon of post-pregnancy acquired pelvic venous insufficiency will progress. They can occur in the groin, perineum, pubic sockets and also in the labia. It is estimated that up to one in five women may experience varicose veins during pregnancy. After delivery, persistent pelvic venous leakage (the venous channels connecting the small pelvic system to the veins of the lower limbs) and varicose veins of the intimate area arising secondary to them are equally common. However, they are smaller, making them more difficult to identify. Although the problem is quite common, many women choose not to seek medical consultation and treatment.

Symptoms - how do you know if you have varicose veins?

Varicose veins of the intimate area are not only an aesthetic problem, disturbing the appearance of the affected person. Patients with varicose veins may also experience persistent lower abdominal pain and a feeling of heaviness, as well as redness, burning and itching of the intimate area. If varicocele is present in the labia minora, distortion of the labia often occurs. It is a misdirection to perform perineal and vulvar plastic surgery when the varicose veins are large. The factor that led the skin to become stretched and deformed must first be treated. Patients with varicose veins of the intimate area usually have a congested vaginal wall (this is due to the nature of their formation) and therefore quite often suffer from unpleasant sensations during intercourse. Some patients also report symptoms vulvodyniauncomfortable burning, itching, often pain located in the vulva or vaginal area (Latin. vulva it's vulva).

Patients presenting to the Phlebology Clinic with a problem of perineal or vulvar varicose veins usually also complain of annoyingly enlarged bleeding nodules (so-called haemorrhoids) or even perianal varices. These are diseases with a common origin, and it is important to bear this in mind, especially for ladies with large lesions - adds Dr Cezary Szary.

The discomfort described can be so severe that it effectively impedes the performance of daily activities, whether performed in a sitting or standing position. Sexual intercourse is also made more difficult because venous stasis in the perineal plexus, vulva or vaginal walls leads to congestion, which exacerbates the pain. The congested vaginal mucosa in ladies with severe pelvic congestion can bleed, especially after intercourse. Added to this is the psychological discomfort resulting from the unsightly appearance of the intimate area and constant pain.

How do varicose veins develop?

The development of varicose veins of the intimate area in most cases occurs during the second or third pregnancy. Ladies whose problem has already occurred before or during their first pregnancy usually suffer from some sort of venous compression syndrome or variation in the structure of the venous systemwhich significantly accelerate the appearance of varicose veins in the intimate area.

Pregnancy is a period fraught with hormonal surges, i.e. oestrogen, which causes an increase in blood volume, and progesterone, which has the effect of decreasing the tension of the muscular membrane of the blood vessels. Because of this, the inguinal and vulvar areas become more circulated. Over time, there is the effect of the enlarging placenta and the uterine mass itself, which create a cramping effect in the small pelvis and later in the abdominal cavity of the pregnant woman. This causes all sorts of compression effects, secondary to the distension of the ovarian veins or the branches of the iliac veins.

Thus, disturbances of venous blood outflow from the pelvic floor and from the vulva or perineal area are compounded. The venous plexuses, which are physiologically 2-3 mm each, grow to a size of 8-20 mm. They are very overfilled with backlogged blood and thus stretch.

This is the phenomenon of the so-called pelvic venous insufficiency, the most common affliction of women giving birth, often running secretly and just as secretly leading to venous insufficiency of the lower limbs. You can find out more about this on the Clinic's website: PELVIC VENOUS INSUFFICIENCY.

Additional factors such as lack of physical activity, high excess weight during pregnancy in initially slim ladies, a sedentary lifestyle or genetic load further favour the occurrence of varicose veins.

Diagnosis and treatment

It is important to remember that varicose veins of the intimate area are exclusively symptom of venous disease and in order to treat them effectively, it is first necessary to diagnose the essence of the problem, i.e. to find the factor that caused it - explains Dr Cezary Szary.

Following a medical history of the patient, appropriate examinations are carried out, primarily Doppler ultrasound of the pelvic and abdominal veins, always with assessment of the veins of the lower limbs. In women with a significant problem identified by Doppler ultrasound, an in-depth diagnosis is carried out, very often with an MRI or CT scan (the so-called 'CT scan'). venography). The order of treatment depends on the identified cause. Most often, ladies with varicose veins of the intimate area suffer from pelvic venous insufficiency and treatment should begin with this.

Treatment of varicose veins of the intimate area alone (as in the case of the legs) is a treatment most often doomed to failure. This is due to the large pouring mechanism. In short, it is impossible to patch a colander with numerous perforations when you pour water into it all the time and only close some of the holes. This is wrong by design - explains the phlebologist Dr. Grey.

Modern treatment of pelvic venous insufficiency and the resulting perineal or vulvar varicose veins is highly effective. Carrying out the treatment in the right sequence (typically starting with the venous embolisation and ends with sclerotherapy of varicose veins in the intimate area) gives very good results, also aesthetically. After such treatment, it is then worth thinking about aesthetic treatments that eliminate or mask skin deformities in the bikini area.

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