Varicose veins of the vulva The Phlebology Clinic / Pelvic venous insufficiency in women / Varicose veins of the intimate area / Varicose veins of the vulva Introduction Description of the condition Risk factors Treatment methods Frequently asked questions Introduction Varicose veins of the vulva and crotch (Vulvoperineal varices), also known as varicose veins of the intimate area, are a relatively common venous condition affecting women of reproductive age. They represent a significant medical problem affecting a significant group of women, especially during pregnancy and after childbirth. According to current epidemiological data, this condition occurs in approximately 22-34% women with pelvic varicose veins in the course of pelvic venous insufficiency. Their incidence of vulvar and perineal varicose veins may be underestimated due to a lack of knowledge among gynaecologists on the subject. Vestibular varicose veins of the vulva can cause considerable discomfort and impair the quality of life of ladies. For many years, spider veins were equated with an aesthetic defect. We now know that this is a gross oversimplification and is usually not the case. The occurrence of vascular spider veins is a harbinger or expression of a larger venous problem. It is therefore useful to understand the causes of their formation, ways to prevent them and to become familiar with the available treatments. Description of the condition Varicose veins of the vulva are dilated, tortuous venous vessels located within a woman's external genitalia. They may occur unilaterally (more often on the left side) or bilaterally, involving the labia majora and minora and the perineal area. They are characterised by the presence of visible, sometimes convex venous vessels that can cause discomfort, burning and a sensation of overflowing blood in the intimate area. Most common symptoms accompanying vulvar and perineal varicose veins are: swelling of the labia and/or the perineum a feeling of heaviness and spreading discomfort during physical activity, sitting and walking soreness and swelling during intercourse (venous dyspareunia) itching and burning in the intimate area deformation of the skin of the vulva and the perineum sharp and burning pain when the veins in this area become inflamed. Post-pregnancy vulvar varices with lesser dilatation of venous plexuses on the posterior perineal side. MR venography. Risk factors pregnancy (due to increased hormone levels, increased circulating blood volume and pressure of the enlarged uterus on the venous drainage of the pelvic floor) polygamy - each subsequent pregnancy increases the risk of developing vulvar varicose veins. multiple pregnancies - is at particularly high risk of developing vulvar and perineal varicose veins. genetic predisposition to venous insufficiency and easy dilatation of veins abdominal obesity - results in increased intra-abdominal pressure and, in the sitting position, impaired outflow from the level of the external vulvar venous drainage. chronic constipation - causing varicose veins of the perineum, less commonly of the vulva. early occurrence pelvic venous insufficiency - Patients who develop venous insufficiency before pregnancy have a much higher risk of developing vulvar varices after their first pregnancy. anatomical abnormalities in the structure of the venous system leading to disturbances of venous blood outflow from the small pelvis (e.g. May-Thurner syndrome) and secondary dilatation of the venous bed. Pregnancy is the most important factor increasing the risk of perineal and vulvar varicose veins in women. Mechanism of formation The formation of vulvar and perineal varicose veins is closely linked to the anatomy of the pelvic venous system in women. A key role in the formation of varicose dilated venous plexuses located in the vulva and perineum is played by the so-called venous leakage points (English. pelvic leak points), through which blood can flow backwards from the pelvic venous system into the superficial veins of the vulva and perineal area. We often compare venous leakage of the pelvic floor or inguinal canals to a leaking ceiling due to flooding from a neighbour above us. We distinguish 3 main The (most common) points of venous leakage leading to the development of perineal and vulvar varicose veins: crotch perineal point (PP) - located where the perineal vein passes through the perineal fascia groin inguinal point (IP) - located in the inguinal canal, associated with the veins of the ligamentum obtus uteri clitoral clitoral point (CP) - near the junction of the clitoral and labial veins Significant dilatation of the pelvic venous vessels and secondary (often perpetuated) dilatation of venous runoff from the inguinal canals leads to easy formation of varicose veins of the anterior vulva and, subsequently, to venous dilatation located in the posterior perineum. Recognition and diagnosis The modern diagnosis of vulvar and perineal varicose veins (so-called varicose veins of the intimate area) is based on several key elements. A medical history and analysis of typical clinical symptoms are key elements that a phlebologist or gynaecologist consulting a patient with suspected varicose veins of the intimate area must never forget. Remember that varicose veins are always only a symptom of a disease, and the doctor's role is to find the cause of their formation. The most common mistake in the presence of perineal and vulvar varicose veins is to ignore them, downplaying the problem and overlooking the treatment of venous insufficiency. The presence of varicose veins of the intimate area always indicates a problem located in the abdominal and pelvic veins. Varicose veins of the posterior perineum and vulva 2 years after venous embolisation imaged by MR venography. This is a typical example showing that venous embolisation alone is not sufficient to cure varicose veins of the intimate area. In terms of diagnostic imaging, a Doppler ultrasound scan assessing the anatomy and blood flow within the abdominal and small pelvic veins should always be performed. It is important that the ultrasound examination is also performed in the standing position with assessment of venous leakage from the pelvis to the lower limbs. Trans-shell ultrasound examination with assessment of the perineum and inguinal canals is key in planning appropriate treatment. Transvaginal examination is of little diagnostic value in the assessment of varicose veins of the intimate area. For treatment planning and as part of the extended diagnosis of pelvic venous insufficiency and secondary perineal and vulvar varicose veins, the most relevant of the diagnostic tests is the magnetic resonance venography (MRV) performed with the administration of a contrast agent in an appropriate protocol. Treatment methods Varicose veins of the vulva and perineum always require specialised diagnosis and individually tailored treatment. Modern treatments for vulvar and perineal varicose veins are minimally invasive and highly effective. It is important to choose the treatment method that is right for you and to implement it early enough. The biggest mistake in the treatment of varicose veins of the intimate area is to close them with sclerosants without imaging diagnostics. Often after such treatments (so-called non-haemodynamic treatments), venous disease progresses, a collateral circulation develops and symptoms typical of pelvic venous insufficiency are exacerbated. This is why it is so important to treat varicose veins of the intimate area causally with a descending strategy and sequential (staged) approach. For this reason, it is not uncommon to treat pelvic venous insufficiency first, followed by lower limb venous congestion and secondary arising insufficiency (descending approach). In pregnant women Treatment of perineal and vulvar varicose veins is usually conservative. It is important to use belts to support the perineum, vulva and inguinal canals and to use daily stockings or compression tights with adequate compression strength. In ladies with large vulvar varicose veins (indicative of advanced pelvic venous insufficiency), it is often necessary to use anticoagulants during pregnancy and the postpartum period. In Ladies after childbirth: treatment depends on the severity of the symptoms of perineal and vulvar varicose veins. It should always start with a change in lifestyle habits, i.e. strength training and avoiding prolonged standing and sitting. Causal treatment, usually starting with sequential treatment, consists of switching off abdominal and pelvic venous insufficiency. Various techniques are used to achieve this venous embolisation and venoplasty. For the treatment of perineal and vulvar varicose veins themselves (once the cause has been treated), the most common treatments are targeted foam sclerotherapywhich involves the injection of a obliterating substance into the varicose veins, causing their irritation and fibrosis. Surgical methods of ligating and resecting the venous vessels in the perineal and vulvar areas are used in advanced cases. This type of procedure is performed under local anaesthesia and involves minimally invasive cutting and ligation of the veins in areas of venous leakage. Varicose veins of the intimate area - how to treat them? Are varicose veins of the intimate area making your life difficult? 😫 You don't have to put up with it! Discover modern and minimally invasive treatments that will bring you relief. Everything you need to know, in one place! ✅ Mostlyquestions asked Is physical activity and sport advisable with varicose veins in the vulva and perineum? Appropriate physical activity is an important part of every person's life. In the case of varicose veins of the intimate area, walking and swimming are recommended,yoga or moderate stationary cycling. Avoid: contact sports, intense weight-bearing exercises, jumping and long rides on a regular bike. Are vulvar and perineal varicose veins a common problem in women? Varicose veins of the vulva and perineum (the so-called 'perineum'). varicose veins of the intimate area) affect approximately 4-10% women, especially those giving birth. They most often occur during or after pregnancy, when increased abdominal pressure and rapid hormonal changes favour their development. The problem is far more common in women who have had more than 2 pregnancies. In multiparous women, they can be very troublesome. Their occurrence in the post-pregnancy period is usually indicative of advanced pelvic venous insufficiency. Can vulvar varicose veins resolve spontaneously after childbirth? Vestibular varices of the vulva may diminish after delivery, especially if it was the first pregnancy. After the 2nd or 3rd pregnancy, their occurrence is usually associated with post-pregnancy perpetuated pelvic venous insufficiency and the formation of significantly dilated venous connections that do not withdraw, tending to widen. This makes the problem increasingly troublesome for the woman. Varicose veins of the vulva and perineum visible to the naked eye always require specialist consultation and appropriate treatment. What are the most effective methods for relieving vulvar varicose vein pain? The most effective methods of temporary relief from perineal and vulvar varicose veins are: applying cold compresses, wearing special compression underwear, taking phlebotropic medication prescribed by a phlebologist, avoiding prolonged standing and sitting, and weight-bearing exercises. It is recommended to periodically elevate the legs and hips while resting. In what situations do vulvar varicose veins require immediate medical consultation? Immediate phlebology consultation require Patients who experience an exacerbation of symptoms resulting from having perineal and vulvar varicose veins (i.e. severe, acute pain in the varicose area with redness - venous thrombosis suspected) or bleeding in the area. Related issues 01 / Pelvic venous insufficiency in women 02 / Uterine varices 03 / Varicose veins of the intimate area Modern vein treatment We offer treatment both on an outpatient basis and in day ward admissions. The stay is of short duration. The patient spends between 1 and 5 hours in the Clinic. Make an appointment
