Sclerotherapy of varicose veins of the intimate area

"What is sclerotherapy for varicose veins of the intimate areas?

Sclerotherapy of varicose veins of the intimate area is a minimally invasive method of treating varicose veins that involves injecting a special obliterating agent (sclerosant) in the form of a foam into them. This causes them to shrink and, as a result, close off through a mechanism of overgrowth (fibrosis). In most cases, varicose veins of the intimate areas are secondary to pelvic venous insufficiency. Therefore, they are a typical symptom, not a disease in themselves. For this reason, sclerotherapy performed at the Phlebology Clinic is usually one of the stages of the so-called causal descending treatment, and not its sole component.

We perform the sclerotherapy procedure for varicose veins of the intimate areas under the guidance of an ultrasound probe (the so-called echosclerotherapy), which ensures precision and safety and allows for monitoring the entire process of drug administration. During the procedure, we use appropriately sharpened and thin needles, and the Patient is in a gynecological position. This guarantees comfort and optimal access to the treated area. Our team has the most extensive experience in Poland in treating this type of condition. We apply a proprietary approach to sclerotherapy in this location. Our method of treatment – focused on causally solving venous problems – has been proven by over 10 years of observations. We encourage you to familiarize yourself with our scientific research in this area.  

Where do varicose veins of the intimate areas most commonly occur?

The sclerotherapy procedure for varicose veins of the intimate areas is particularly recommended for Patients who have previously undergone causal treatment pelvic venous insufficiency. This is usually a prerequisite for the effectiveness of the therapy.

Sclerotherapy for varicose veins of the intimate areas is an effective treatment method in the following cases:

• varicose veins of the labia: enlarged, twisted veins in the area of the labia majora, sometimes minora, which can cause pain, discomfort, unaesthetic appearance, and stretching of the skin in this area (in most cases, they occur after the 2nd or 3rd pregnancy);
• varicose veins of the middle or posterior perineumvaricose veins occurring in the perineal area, often accompanying varicose veins of the labia; they usually appear as the first sign due to the development of so-called venous leaks of the posterior perineum during the 1st pregnancy;

varicose vein from the posterior part of the perineum

varicose veins of the inferior gluteal venous system

varicose veins descending from the perineum and the anterior part of the vulva

• varicose veins in the inguinal region: enlarged veins in the inguinal region, originating from the inguinal canals, are always associated with pelvic venous insufficiency; their treatment must take place after treating the underlying cause, which is pelvic venous insufficiency! Treating veins in this area requires considerable experience, knowledge, and skill. Therefore, we do not recommend treating varicose veins in this area to novice phlebologists.
• enlarged veins of the mons pubis: varicose veins within the mons pubis, often co-occurring with varicose veins of the labia and are usually associated with pelvic venous insufficiency.

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What are the indications for sclerotherapy of varicose veins in the intimate areas?

Indications for performing sclerotherapy of varicose veins in the intimate areas include not only aesthetic concerns but also ailments such as:

• lower abdominal and intimate area pain, which can be dull, chronic, or periodically worsening, especially at the end of the day or after prolonged standing;
• a feeling of heaviness in the lower abdomen, especially worsening after strenuous exercise and long bike rides;
• burning and itching of the intimate areas; these discomforts often intensify in the evening and after intense physical exertion;
• dyskomfort i ból podczas stosunku (tzw. dyspareunia; these discomforts can significantly impact the quality of sexual life and cause problems in intimate relationships. The pain can be superficial (at the entrance to the vagina) or deep (felt during deep penetration);

• distortion of the labia resulting from their stretching and swelling (post-pregnancy venous-related tissue deformation); these changes can be asymmetrical and lead to discomfort while sitting or wearing certain types of clothing;
• symptoms of vulvodynia, which includes spontaneous burning, itching, and pain of the vulva or vaginal vestibule not provoked by external factors; this condition can significantly impact daily functioning, causing chronic discomfort and problems with sitting, walking, or performing basic activities;
• congestion of the vaginal walls, causing discomfort and possible spotting during and after intercourse; this may be accompanied by a feeling of fullness and increased sensitivity to touch.

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Description of the sclerotherapy procedure for varicose veins of the intimate areas

It is best to schedule the sclerotherapy procedure for varicose veins of the intimate areas outside of the menstrual period (monthly bleeding). Such scheduling not only ensures greater comfort for the Patient but also allows for optimal conditions for performing the procedure and subsequent healing. If pregnancy is suspected, the procedure will not be performed. It is worth checking this beforehand.

At the Phlebology Clinic, we perform the sclerotherapy procedure for veins in the intimate areas using echosclerotherapy (the procedure is performed percutaneously under the guidance of a high-resolution ultrasound probe). This allows for precise administration of the medication into the altered and enlarged venous vessels of the labia, perineum, or groin. For this purpose, we exclusively use foamed sclerosants at the appropriate concentration and dose.

Post-procedure care after sclerotherapy of veins in the intimate areas

Following the sclerotherapy procedure for varicose veins of the intimate areas, we recommend our Patients:

• an intensive walk immediately after the procedure (preferably 30-40 minutes);
• leaving the compression dressing at the injection site for 5-7 hours after the procedure;
• wearing special compression underwear (if prescribed);
• wearing compression stockings (usually in compression class 2 – CCL2) – for the period indicated by the doctor performing the procedure (usually from 5 to 10 days);
• applying heparin gel to the injected areas (2-3 times a day);
• avoiding strenuous physical activity for approximately 7-10 days after the procedure.
• abstaining from sexual intercourse for 3-7 days after the procedure (it all depends on the extent of the procedure and the location of the treated lesions);
• a follow-up visit with an assessment of the venous sufficiency of the lower limbs 3-5 weeks after the sclerotherapy of the veins in the intimate areas.

Furthermore, for 7-10 days after the procedure, it is advisable to wear comfortable underwear that will not cause additional pressure or digging into the intimate areas.

Complications after foam sclerotherapy

Sclerotherapy of varicose veins of the intimate area, like any phlebological procedure, carries a certain risk of complications. At the Phlebology Clinic, we make every effort to minimize them by treating Patients causally and not just symptomatically!

Possible complications of the sclerotherapy procedure include:

1. Complications typical for echoscierotherapy:

• temporary skin discoloration at the injection site;
• temporary phlebitis at the site of sclerosant administration;
• pain or discomfort at the injection site (usually lasting up to 5 days after the procedure);
• skin necrosis at the site of sclerosant administration (very rare, below 1%);

2. Complications specific to the obliterated perineal-vulvar area:

• swelling in the intimate areas;
• bruising at the injection site (lasting several days);
• discomfort during walking or sitting (the first few days);
• potentially, although rarely, deep vein thrombosis or pulmonary embolism may occur, especially in Patients with hypercoagulability.

In very rare cases, allergic reactions to the administered sclerosant are also described. It should be emphasized that serious complications after sclerotherapy of varicose veins in the intimate areas occur very rarely. The risk of complications is minimized by the precise execution of the procedure under ultrasound guidance, as well as the patient's medical history taken before the procedure. It is important to inform the phlebologist about any previous thromboembolic events and the possibility of pregnancy.