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Capital Region Vein and Laser Centre | Vulvar Varicose Veins / Pelvic Congestion Syndrome
Vulvar varicose veins usually appear during pregnancy occurring in about 10% of pregnant women. They are rare during a first pregnancy and generally develop during the second trimester of the second pregnancy.
Vulvar Varicose Veins, Pelvic Congestion Syndrome, pregnancy veins, varicose veins
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Vulvar Varicose Veins / Pelvic Congestion Syndrome

Vulvar Varicose Veins/Pelvic Congestion Syndrome

pelvic congestion syndromeMany women suffer from varicose veins of the vulva or vaginal area. Out of embarrassment, women rarely mention vulvar varicose veins and they are not adequately sought in the physical examination by their family doctors.

 

Vulvar varicose veins usually appear during pregnancy occurring in about 10% of pregnant women. They are rare during a first pregnancy and generally develop during the second trimester of the second pregnancy. For the majority of woman vulvar varicose veins disappear after child-birth. In those women with vulvar varicose veins, further pregnancies will worsen the condition to the point that they never completely disappear.

 

Many women suffer from varicose veins of the vulva or vaginal area. Out of embarrassment, women rarely mention vulvar varicose veins and they are not adequately sought in the physical examination by their family doctors.

 

Vulvar varicose veins usually appear during pregnancy occurring in about 10% of pregnant women. They are rare during a first pregnancy and generally develop during the second trimester of the second pregnancy. For the majority of woman vulvar varicose veins disappear after child-birth. In those women with vulvar varicose veins, further pregnancies will worsen the condition to the point that they never completely disappear.

 

Some women have varicose veins located only in the vulvar area. In other women, they not only have vulvar varicose veins but large varicose veins on the inner aspect of the groin and upper thigh.

 

If varicose veins of the vulva persist beyond pregnancy they can produce symptoms such as a dull aching or dragging sensation as well as pelvic pain. This is known as Pelvic Congestion Syndrome.

 

Pain of varying severity is the most common complaint. The pain is typically dull and not cyclical. The pain is usually worse just before the onset of the menstrual cycle, at the end of the day, after prolonged standing, during or just after intercourse. This condition is a result of dilated pelvic varicose veins. These dilated veins are similar to varicose veins in the legs but occur deep in the pelvis, often due to non-working valves in the left ovarian vein. A CT scan or MRI with contrast is needed to make the diagnosis. Treatment will depend on what source veins are producing the symptoms and where they are located.

 

Anatomically this is divided into a Superior Component when the veins involved are located between the renal vein and the Broad Ligament. This is usually a non-working right gonadal (ovarian) vein and is responsible for the pelvic symptoms.

 

The Inferior Component makes up those veins located from the broad ligament to the lower extremities and is responsible for the local vaginal symptoms. Initial treatment decision is symptom driven. If the symptoms primarily involve the lower extremities then focus treatment on the lower venous reflux component. Most pelvic venous pathology does not have an upper component.

Treatment of Inferior Component:

If the varicosities are small and localized to the vulvar region and inner aspect of the thigh then sclerotherapy or ultrasound guided sclerotherapy is most effective. Most patients will require multiple sessions of sclerotherapy to eliminate all vulvar and leg varicose veins.

Treatment of Superior Component:

If patient’s symptoms are severe and of pelvic origin then the focus of treatment is on the superior component. A selective venogram will demonstrate pelvic varicosities filled with contrast. A series of coils are then deposited to mechanically occlude these veins. The coils are deposited in groups at various intervals along the course of the vessel with the last group of coils positioned near the renal vein junction. The ovarian (gonadal) vein is then embolized. A repeat venogram is performed to see if the reflux is eliminated.

 

At the Capital Region Vein Centre we manage Pelvic Congestion Syndrome or Pelvic Venous Insufficiency by first identifying the exact cause and then treating it effectively, using the latest non-invasive diagnostic techniques and minimally invasive procedures.