Vulvar varices most often occur during pregnancy. Generally benign, they can however cause disabling discomfort and pain. How to identify them and especially relieve them? Explanations and advice from Dr. Michel Dadon, vascular doctor in Paris and member of the French Society of Vascular Medicine (SFMV).
Definition: what is a vulvar varicose vein?
Vulvar varices, as their name suggests, affect the vulva. “They are fed by the pelvic veins and develop mainly during pregnancy, due to abdominal and pelvic venous hypertension which prevents correct venous return”, explains Dr Dadon.
In concrete terms, instead of circulating correctly on the way up, the blood tends to flow back down, into the internal pudendal veins, then into the vulvar veins. This area “swells” and therefore becomes painful, usually at the end of the second or third trimester of pregnancy.
Itching, pain, redness… How to recognize the symptoms of vulvar varices?
Vulvar varices appear as bluish or purplish dilations. They are mostly asymptomatic, but can have a strong impact on a daily basis: hypersensitivity and swelling in the vulva, a burning sensation, itching, discomfort during walking, etc. In some cases, there is the appearance of a tortuous vein at the level of the labia majora.
These varicose veins can be very large and painful, confirms Dr. Dadon.
Can a vulvar varices “burst”?
“Varicose veins are uncomfortable, painful and unsightly, but they are not likely to burst“, assures the doctor. And to specify that the formation of clots (venous thrombosis or phlebitis) is extremely rare.
Can these varicose veins be disturbing during sexual intercourse?
Yes, vulvar varices can be painful during sexbut less than pelvic varices.
“They can also be bothersome aesthetically and relationally“, adds Dr. Dadon.
What are the causes of vulvar varices?
Vulvar varices are most often related to pelvic varices. They are linked to the many hormonal changes that occur during pregnancy: hormonal fluctuations promote dilation of the veinswhich slows blood flow, leads to venous insufficiency and thus contributes to the appearance of varicose veins and hemorrhoids.
But vulvar varices can also be independent of pregnancy and linked to venous malformations, says Dr. Dadon.
Other factors, even rarer, can be the cause of vulvar varices:
- the presence of tumors or endometriosis may obstruct blood flow;
- and de Cockett’s syndrome (compression of the left common iliac vein) or a Nut cracker syndrome (compression of the left renal vein);
- and post-thrombotic syndromecharacterized by symptoms of chronic venous insufficiency that appear following deep vein thrombosis.
Diagnosis: which doctor to consult?
Vulvar varices disappear spontaneously following childbirth in the vast majority of cases. “At any rate, we review the situation with the patients six to nine months following their delivery“.
During pregnancy, they can be taken care of by the gynecologist or the midwife responsible for monitoring. And if they persist, they can be taken care of by a vascular physician.
After clinical examination of the vulva and lower limbs, a doppler ultrasound can be performed to observe the arteries and their blood flow, and thus detect possible arterial disease. A pelvic MRI or CT scan can also be made.
Vulvar varices during pregnancy: can pregnant women give birth vaginally? Is the caesarean compulsory?
Yes, pregnant women prone to varicose veins can give birth vaginally.
However, if the vulvar varices are too large and/or painful, childbirth involves a significant risk of variceal bleeding. In this case, the gyneco-obstetrical team may consider a caesarean section.
Prevention: how to avoid the formation of vulvar varices?
It is not really possible to avoid these varicose veins, whatever their origin. The classic measures to prevent venous insufficiency in the lower limbs can however be useful:
- wear compression socks, stockings or pantyhose that promote venous return;
- practice a sport that promotes blood circulation (such as walking, swimming, yoga, etc.);
- perform draining massages in the legs (from the toes to the groin) to improve circulation;
- avoid crossing your legs in a seated position, this can alter venous return;
- apply ice packs in case of pain (cold relieves instantly);
- limit showers and baths that are too hotdeleterious for blood circulation, then end your shower with a jet of cold water going up along the legs;
- favor loose clothing and avoid wearing clothes that are too tight around the pelvis ;
- elevate his feet when lying down, to promote venous return.
If vulvar varices persist beyond three months following childbirth, it is essential to consult a vascular doctor!
Treatment: how to treat vulvar varicose veins?
As indicated above, varicose veins most often regress on their own: “there may be involution”, reminds Dr. Dadon. If necessary, the treatment of vulvar varices goes through treatment of pelvic varices. It is given a few months into pregnancy and consists of preventing venous reflux into the vulvar veins by blocking the varicose veins and allowing blood to be redirected to normal veins (varicose vein embolization).
When the regression of these varicose veins is partial in post-partumclassic sclerosis by external puncture, possibly with sclerosing foam, can be performed in the office.
Of rare cases of vulvar venous malformations may require surgical treatment.
Pregnant women: how to relieve vulvar varicose veins during pregnancy?
Pregnant women can follow all the prevention measures mentioned above. If they are not enough, you can, for example, do compression with a cyclist or very tight panties and thick hygienic protection, says Dr. Dadon.
