Vulvar varicosities are also known as varicose veins of the vulva. Like other parts of your body, the vulva contains both large and small blood vessels. The condition is common in the feet and legs. However, some women get the disease within the genital area. It results when veins dilate within the labia minora and labia majora.
Studies reveal that about 22% to 34% of women experience vulvar varicosities. In pregnancy, about 18% to 22% of women are likely to experience similar conditions. In the post-partum period, there is enlargement and persistence of perineal vein in 4% to 8% of women. Note that not every woman with the varicosities will experience varicosities in the vulva will have or notice the symptoms. Even in the presence of symptoms, the affected woman may not see the veins.
When a section of the veins gets twisted, dilated, enlarged, and overfilled with blood, there is a high possibility of developing vulvar varicosities. The condition is associated with discomfort, pressure, and pain within the affected part. The high prevalence of vulvar varicosities in pregnant women results from variation in blood flow and elevated hormone levels, causing enlargement of the vulvar veins.
For most pregnant women, the condition resolves after delivery without any specialized treatment. If you experience persistent vulvar varicosities post-delivery or experience the situation in the absence of pregnancy, consider reaching out to a physician for appropriate medical attention.
Symptoms of Vulvar Varicosities
Besides the swollen or twisted veins within the genitals, women are likely to experience pain in the genital area. The affected area will feel sore and tender, resembling a bruise. Other symptoms associated with vulvar varicosities include:
- Severe pain exacerbating after standing, physical, or sexual activities.
- Swelling around the genital area.
- A sense of fulness or pressure within the genitals.
Disruption of the vulvar veins may also interfere with the perineum, which lies between the anus and the vagina. A fraction of women experiencing vulvar varicosities can develop haemorrhoids. Pregnant women with vulvar varicosities may not notice that they have the condition. Besides the minor and major labia occurrence, skin folds and lips of the vulva are also affected.
For easy identification, you may realize blue-coloured veins at the affected site. The veins are often soft and seems bulge and twist out of the skin. Also, there could be itchiness within the affected part.
Causes of Vulvar Varicosities
There are diverse risk factors for the development of vulvar varicosities, including:
1. Pregnancy
Vulvar veins are part of the various undesirable conditions that pregnant women are likely to experience. There is increased blood flow to the lower part of the body in pregnancy, including the genitals. It’s because of the pressure exerted on the pelvic region by the developing fetus and expanding uterus. For adequate ad complete circulation, the veins must operate against gravity in returning the blood to your heart.
In pregnancy, the veins work harder. The valves within the veins ensure unidirectional blood flow, preventing blood flow in the opposite direction. The elevated pressures and increased flow of blood may damage the valves rendering them defective. Since the valves cannot close properly, there could be a backward flow of blood. The outcome is the pooling of blood within the veins causing varicose veins.
Varicose veins rarely cause complications during childbirth. It is easy to manage any bleeding during delivery because the affected veins experience a low blood flow. Note that the number of vaginal veins reduces after delivery but may persist in some instances in the absence of treatment. Subsequent pregnancies may exacerbate the condition.
It is rare for females to develop vulvar or vaginal veins in the absence of pregnancy. If it happens, the following could be the risk factors:
2. Family History
Genetics have a role to play in your susceptibility to varicosities. If your direct family members, such as grandmother or mother, suffered or suffers from the varicosities, you may be at risk of developing the same. The varicosities could be anywhere within the body, including the vulva and the vagina.
3. Prolonged Standing Period
Standing for an extended period imply that the blood will not flow well as compared to when moving. Without mobility to encourage blood flow, blood pooling within the veins creates weakness and pressure in the veins. The above processes lay a foundation for the aetiology of varicosities.
4. Age
Female gender within the childbearing age of 25 and 45 years are more prone to developing vulvar varicosities. However, older women may also experience vulvar varicosities. As one ages, the veins get less elastic and are unable to function effectively. The outcome is the slowing down of the venous blood and the blood’s pooling within the veins. It results in the development of varicose veins.
5. Pelvic Congestion Syndrome
It is associated with the development of the varicose veins within the ovaries. Note that the advancement of varicose veins is similar throughout the body irrespective of the site affected. The weakened valves within the ovarian veins become defective and unable to close correctly. It obstructs the flow of blood to the ovarian veins. The blood flows back, causing pooling of the blood and eventually varicosities. Women who deliver naturally are prone to pelvic congestion syndrome. More risk factors for PCS include being overweight and tipped uterus.
6. Hormones
During pregnancy, there is a high hormone fluctuation causing dilation of veins. It predisposes pregnant women to varicosities. Besides, the hormonal changes exert extra pressure on the inferior vena cava. Disruption of the vein may predispose one to developing the vulvar varicosities.
Risks, and Complication
Stasis of blood within the veins may cause a harmful blood clot known as deep venous thrombosis (DVT). The blood clots within the vein can break and move through the circulation to different parts of the body. DVT is a harmful condition though it is rarely associated with vulvar veins. However, the physician must monitor the patient’s veins to confirm that there is no formation of the blood clots.
Signs of blood clot formation include veins getting painful, rigid, swollen, and red. Women who experience such symptoms should promptly reach out to the physicians. Symptoms associated with vulvar varicosities are temporary. Women may fail to notice them in one pregnancy but realize them in the next gestation period.
Diagnosis
Apart from the swollen veins, most women with vulvar varicosities lack significant symptoms. Through visual examination, the physician will diagnose the condition. Note that vulvar varicosities could be an indication of a circulatory challenge. Through history taking and physical examination, the doctor may notice an abnormality in the circulation.
In some instances, ultrasound could be necessary in the diagnosis of vulvar varicosities. The imaging will assist your physician in identifying the varicose veins and evaluating the severity of the condition. Ultrasound will also reveal any blood clot within the blood vessels. An ultrasound is also useful in identifying the damaged valves and flow of blood in the opposite direction.
Physicians may also incorporate other tests to know the scope of the problem. When physicians suspect larger venous issues such as pelvic congestion syndrome and pelvic venous insufficiency, they may consider using:
- Selective venography.
- Magnetic resonance angiography.
- Heart scan.
Treatment of Vulvar Varicosities
Blue veins in the female genital area can be embarrassing and uncomfortable. However, they rarely indicate any severe condition. Those associated with pregnancy often resolve on their own without serious medical attention. If they persist, the following interventions may be necessary:
1. Thermal Ablation Therapy
In this technique, the physicians make a small incision after administering a local anaesthetic to the patient. The physician will insert a fibre into the damaged vein. Radio-frequency will then get transmitted through the fibre, causing collapse to the damaged vein. After the thermal ablation technique, you will resume your daily operations while avoiding strenuous activities. You may notice minor discomfort, which is relieved quickly by the use of the over-the-counter medications.
2. Cyanoacrylate Glue Therapy
It is a relatively new method in the management of varicose veins. The technique incorporates the use of cyanoacrylate, which resembles a glue. In the past, doctors used the technique in treating abnormalities of the blood vessels. The procedure does not involve the use of local anaesthetics, burning, or heating. Your physician will inject some little glue into the affected vein causing it to close.
Blood will re-route via the healthier veins. It is a quick technique with immediate recovery because of the absence of anaesthetic, skin incision, and drugs. However, there could be discomfort and mild pain in the area of treatment. The pain is quickly relieved by the use of anti-inflammatories. Besides, leg elevation, rest, and walking are preferable after cyanoacrylate therapy.
3. Laser Treatment
It is vital in the management of vulvar or vaginal veins. The physicians will insert a tiny catheter having a fibre optic laser via a small incision on your skin into the affected vein. The probe will emit laser energy pulses that heats the walls of the damaged vein leading to collapse.
The damaged vein is absorbed by the patient’s body eventually. Laser therapy is one of the outpatient procedures, and the technique consumes less than one hour. After the treatment, it is natural to experience some mild pain or bruises. Such discomfort is minor and temporary.
4. Sclerotherapy
Sclerotherapy is one of the most common techniques used by physicians to eliminate the blue veins in the genital area. The procedure is the most suitable for veins with thin walls. During the process, the physicians inject a solution known as sclerosant into the damaged vein. Through sclerosis, the solution hardens the vein. It allows the blood to re-route via other normal veins.
The surrounding tissue will absorb the damaged vein. Most patients prefer sclerotherapy because it involves minimal invasive techniques. Besides, it’s the most effective in treating small varicosities. For more extensive varicosities, foam sclerotherapy is the most suitable. In this technique, the physicians combine the sclerosant with air bubbles to obtain the foam.
The combination allows the sclerosant to access the walls of the veins to cause collapse. As the damaged vein gets absorbed, blood re-routes through the healthy veins. The patients may experience mild phlebitis, discomfort, or bruising. The symptoms or pain are quickly relieved by the use of OTC medications. Severe complications are rare with the help of sclerotherapy.
The doctors may also recommend home-based therapy in the management of vulvar varicosities.
- Application of ice pack to the affected region.
- Relieving pressure by changing body positions regularly.
- Wearing of compression stockings.
If the symptoms are severe or linked to other conditions, the physician may advise that:
- Take prescription drugs such as low molecular weight heparins to dislodge the blood clot. The low molecular weight heparins are useful in the treatment and prevention of blood clots. For pregnant women, they can take the medication in the late trimester as a five-day course.
- Use a gentler soap when cleaning the genital area.
Prevention of Vulvar Varicosities
Prevention of vulvar veins is a great challenge, more so in pregnancy. Patients who already have the condition should closely monitor it to prevent exacerbation. Caution is also necessary to avoid multiple varicosities in different parts of the body. Women of childbearing age should consider the following:
- Regular exercise.
- Elevation of legs while sitting.
- Wearing of compression stockings.
- Healthy eating and monitoring of weight.
- Sleeping with the hips raised slightly to prevent pooling of blood within the pelvic region.
- Avoid standing or sitting for a prolonged time.
- Taking plenty of water daily to ensure adequate hydration.
Women should shun wearing clothes that are too tight at the groin or waist area. Patients with underlying varicosities in the legs should promptly seek medical attention and wear supportive garments like compression stockings. Besides, they should avoid being overweight and avoid postures that could pressure the damaged veins. Such precautions are effective in minimizing the risks of developing vulvar varicosities.
Vulvar varicosities could be frightening and embarrassing for the women to share with their physicians. However, it’s a common problem, and there is no cause for alarm. If you notice signs of vulvar varicosities, promptly contact your doctor for guidance and medical help.
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