Vulvar Varicose Veins (Vulvar Varicosities) and Pelvic Congestion Disorder: What you need to know

Pregnancy is the primary risk factor for developing vulvar varicosities. A less recognized condition that can cause pelvic veins is the narrowing of the major vein (iliac vein) that drains each leg.

Vulvar varicosities are seen in the vagina and labial area but can also be seen in the groin and buttocks. These veins are the visible manifestation of varicose veins in the pelvis near the ovary, uterus, bladder and rectum. The location of the superficial varicose veins indicates the pelvic vein that may be the underlying cause.

Natural changes of pregnancy contribute to vulvar varicosities. These include weight gain with increased pressure on the pelvic floor, increased venous blood volume, and the dilation of the pelvic ligaments and veins of the leg. These changes result in pooling of venous blood with pregnancy. The risks of developing vulvar varicose veins and more common leg varicose veins grow with each pregnancy.

Vulvar varicose veins can appear as early as 12-26 weeks into the pregnancy. In most cases, they go away on their own six to twelve weeks after delivery. In some, the vulvar varicose veins do not resolve and symptoms of a condition known as pelvic congestion disorder (PCD) can affect your quality of life. Symptoms often worsen with the menses, long periods of standing, or sexual intimacy.

While vulvar varicose veins affect more pregnant women, non-pregnant women can develop pelvic congestion and/or vulvar varicosities. The most common causes appear to be:

• Portal hypertension: increased blood pressure in the portal vein, which receives blood from the pancreas, spleen, stomach, and intestines
• Scarring of the iliac veins which drain each leg.
• Klippel-Trenaunay Syndrome (KTS): a rare congenital disorder (disorder from birth), with unknown causes

You can have vulvar varicosities and not be aware of them, as they are not always visible. Vulvar varicose veins may, also, present with one or more of the following symptoms:

• Vulvar pressure or fullness
• Vaginal/vulvar swelling
• Genital discomfort or pain
• Bluish, bumpy, or bulging visible veins
• Urinary urgency or pain
• Hemorrhoids and or rectal pain.

More extreme cases include bulging visible veins on or near the genital area. In pregnancy, varicose veins in the legs are very common. Some studies indicate that up to 20% of women with varicose veins in the legs, also, have vulvar and pelvic veins. For some women, these veins subside on their own after giving birth. If not, it could be in indication of Pelvic Congestion Disorder (PCD).

Pelvic Congestion Disorder symptoms include:

• Pelvic pain similar to contractions or a heavy menstruation
• Painful intercourse
• Pain in the pelvic area and legs after intimacy
• Difficult or painful urination

Regardless of the cause or symptoms, help is available at Vein Specialists of the South.

A specialized team dedicated to the evaluation and treatment of vulvar varicosities and PCD is important. The diagnosis begins with a detailed history and physical exam. If indicated, our team of licensed medical professionals performs specialized duplex ultrasound for the diagnosis of vulvar varicose veins and leg veins. Based on these findings, we may recommend further testing. That would include a venogram for imaging of the veins most likely to cause pelvic and vulvar varicose veins.

The initial treatment for vulvar varicosities and PCD is conservative measures. If you are already a patient at Vein Specialists of the South, you will recognize our Better Veins for Life® Principles.

• Leg elevation to promote better circulation and changing your position more often to prevent blood pooling
• Wearing support garments designed to reduce groin and leg vein pressure
• Regular exercise
• Healthy weight management

If you have vulvar varicose veins and leg varicose veins, your symptoms help determine the best treatment approach. With limited pelvic symptoms, the leg veins are often treated first.

If your vulvar varicose veins and PCD symptoms are more severe, procedures treating the pelvic veins may be recommended before treating your legs veins..

The treatment of choice is a diagnostic venogram, an injection of the veins to identify the cause of the pelvic veins followed with minimally invasive measures to correct of the unhealthy pelvic veins.

Despite conservative measures, including specialty compression garments,the pain of vulvar varicose veins can affect quality of life and prevent normal daily activities. For those patients, continued conservative measures, rest, and avoiding prolonged standing is needed to get through the pregnancy.

Most vulvar varicosities do not interfere with a safe vaginal delivery. However, more advanced cases may require treatment during pregnancy to prevent rupture and hemorrhage during delivery, which would put the mother at risk. Please seek an evaluation to determine the best approach to treating these unhealthy veins.

Under guidance from your OBGYN, you may opt for a cesarean. However, this is usually only recommended in cases where varicosities are very large and the risk of hemorrhage is very high.

For the majority of expectant mothers, smaller vulvar varicosities clear up between six and twelve weeks after delivery. If they do not, please contact us for further evaluation and treatment.

Vulvar varicose veins occur in about 2-4% of pregnancies. When larger or symptomatic, they are likely to be diagnosed at your routine OB visit. Others cases are probably missed, as evidenced by the fact that 20% of patients with leg varicose veins also have pelvic veins, even if there are no visible vulvar, vaginal, or labial veins.

These conditions can occur together, but that’s not always the case. You are at greater risk for both types of varicose veins during pregnancy, however. Studies indicate that 20% of patients with leg varicose veins have pelvic vein disease.