Vulvar Varicosities

Varicosities is a another name of the pathology of varicose veins. This disorder does not pose any danger to human health but it causes great discomfort. The disorder affects both men and women but more frequently occurs in women.



Localization:

  • Lower extremity varicose veins;
  • Vaginal varicose veins, vulvar varicose veins;
  • Varicose veins of the uterus;
  • Pelvic varicose veins.


The mechanism in the development of varicosities is the same in all the types of the disorder – overflow in the venous circle leads to the venous stretching and the loss of elasticity, the venous valves do not close and cause return blood circulation, congestion occurs and the veins expand even more.

Causes

There is no scientific evidence relating to the causes of varicose veins of the groin in women, but the experts name some risk factors.

Predisposing conditions:

  1. Elderly age;
  2. Many pregnancies and deliveries;
  3. Occupational hazards (strenuous physical activity, long periods of sitting or standing in one and the same position);
  4. Lack of orgasm during sex;
  5. Sexual abstinence;
  6. Rejected sexual intercourse as a method of contraception;
  7. Dyspareunia (painful sexual intercourse);
  8. Hereditary background.

Most often the clinical presentation of a severe vaginal varicose veins occurs during pregnancy.

Factors that contribute to the development of varicose veins in pregnant women:

  • Hormonal imbalance. An elevated level of progesterone leads to the weakness of the vessel walls tone and, consequently, to the venous stretching.
  • Reduction of physical activity. Lack of walking and gymnastics causes pelvic blood congestion.
  • Elevation of the venous pressure. As the fetus needs to be fed, the blood in pregnant women has more fluid and that leads to the vaginal varicose veins.
  • Changes in blood coagulation properties. These changes are especially characteristic in the third trimester of the pregnancy when a woman’s body begins to get ready for the delivery.

Clinical presentation of vaginal varicose veins

At the early stages a patient may have no symptoms of the disease. Symptoms of the vaginal varicose veins appear during a pregnancy. In the majority of patients, the disorder is characterized by a compensation stage and it disappears after the delivery, but in some cases decompensation may  appear:

  • Pain (continuous, tensive, nagging, burning, dull) which is expanded to the vulvar area and lower extremities;
  • Sensation of heaviness in the vagina;
  • Pain during and after a sexual intercourse.

Some female patients may experience a pain crisis, that is the event in which the patient reports sudden and extremely severe attacks of pain. Pain crisis may occur because of stress, excessive heat loss, chronic fatigue or due to the chronic disorders of different body organs and systems.

Other types of vaginal varicose veins:

  1. Varicose veins of the grain (a bursting sensation, visually the veins are swollen and enlarged);
  2. Varicose veins of the uterus (the most threatening type of the disorder which occurs after inflammations, abortions, gynecological dysfunctions related to the circulation disorder).

Thrombophlebitis is a complication of the varicose veins, which is characterized by an extreme pain syndrome, signs of intoxication (rapid heart, fever, dizziness and weakness). This condition requires   medical emergency call and immediate treatment.

Diagnosis of vulvar varicosities

The most precise diagnostic method  is a gynecological examination.




A gynecologist may detect the following signs of the vaginal varicose in pregnant women:

  • venous tortuosity;
  • nodes of varicose;
  • redness and  edema;
  • subcutaneous pinprick bleeds;
  • bluishness of the skin and mucous membranes.

Bimanual examination with the help of a special gynecological speculum enables a doctor to detect:

  • sharp pain in case of vaginal varicose veins in pregnancy;
  • lack of vessels and thrombi elasticity;
  • bluishness of the mucous membranes;
  • venous tortuosity and enlargement of the veins;
  • mucous hypertrophy.

These methods help to diagnose varicose veins, however there are some other additional tests to confirm the diagnosis and prescribe proper treatment.

Additional methods to test blood clotting ability:

  • prothrombin ratio;
  • tolerance to heparin;
  • clotting time;
  • fibrinolytic activity;
  • autocoagulation test.

Preventive measures for pregnant women

Varicose veins in pregnancy does not usually pose any risks for mother or for a fetus. However, women with vaginal varicose veins in pregnancy should take some preventive measures to avoid the complications of the disease:

  1. Weight control. Sudden changes in the weight and body weight increase (more than permitted) are not allowed.
  2. Avoid excessive physical loads.
  3. Active style of life. Pregnancy is not a pretext to avoid walking or doing gymnastics, only of if there are no contraindications and threatening miscarriage.
  4. Wear comfortable flat shoes.
  5. Avoid wearing too tight socks, knee-socks, stockings.
  6. Regularly keep your legs raised when you are lying or sitting for better blood outflow from the veins.
  7. Sleep or lay in bed on your left side to avoid the pressing on the pelvic venous plexus.
  8. Relaxing baths and massage to improve blood circulation.
  9. Diet rich in the foods containing vitamins E, C and A.

Therapeutic approach and management of pregnant women

A drug-free treatment of women with vaginal varicose veins in pregnancy includes the aforementioned preventive measures, blood clotting ability control and consultations at a gynecologist and phlebologist.

Prescribed medications:

  • vasoprotective drugs;
  • veinotonics;
  • anticoagulants ((if indicated, stop taking the drugs shortly before the delivery);
  • sedative drugs.

In compensated disease state the use of drugs is not required. What measures should undertake a woman with a vaginal varicose veins in pregnancy, depends on the severity of the disorder. In severe varicose veins a cesarean section is required. Otherwise, a woman should have a natural childbirth, but careful observation is strongly required to avoid bleeding and thromboembolic episodes.

Bleedings caused by the tear of vaginal veins are copious and it is necessary to stop the bleeding immediately. It is not permitted to stop the bleeding by a blind suturing as almost all nodes of varicose are invisible and there is a great risk to damage them.

Vulvar varicosities after delivery

Even a successful childbirth without any complications or tears of vaginal veins does not ensure that the disease is going to disappear soon. Rather frequently, this pathology transforms into thrombophlebitis and it requires urgent treatment.

Indeed, some women get rid of the disease after the delivery, but those who still experience discomfort have to options to cure the disease:

  • Conservative. Antibacterial, anti-inflammatory medications, analgesics and anticoagulants are used.
  • Surgical. Resection of affected veins.

Surgery and the use of anticoagulants are indicated not earlier than four days after the delivery to avoid an excessive loss of blood.

In general, vaginal varicose veins is the disease which affects most often pregnant women. It is very important to have gynecological examinations and follow all the recommendations of the doctor to have happy and safe pregnancy and delivery.