Varicose Veins of the Labia

Also referred to as varicose veins of the vagina, vulva, “privates” or female genitalia, varicose veins sometimes occur on the labia major, labia minor and in the vagina. Usually they appear in the second trimester of the second pregnancy in 10% of pregnant women. They are similar to varicose veins of the legs but occur in the vulva area resulting in bulging of the affected labia. Commonly, one labia is more affected than the other, and the pregnant woman often notices that one side of her vulva is bigger and asymmetrically bulging more than the other side. Their appearance are unsightly and cause embarrassment to the patient. They can cause pruritus (itching), a feeling of heaviness, and dyspareunia (pain during sexual intercourse) due to the weight of these varicose veins. These symptoms however are not common, occurring in less than 10% of patients according to Dr Asad R Shamma‘s research. Thrombosis and bleeding of these varicosities are rare.

Most women are embarrassed to discuss their labial varicosities with their doctors and instead put up with the unsightliness of them.

The pressure from the enlarged uterus on the pelvic veins along with the weakening of vein walls from increased levels of female hormones during pregnancy in addition to the increased volume of blood during pregnancy are the direct causes for varicose veins of the labia and vulva. This explains how these varicose veins recede and in many cases actually disappear after delivery.

Less commonly labial and vulvar varicosities can be caused by venous reflux due to faulty valves in one of the branches of the saphenous vein at the saphenofemoral junction; specifically the external pudendal veins. In these case they can occur in nulliparous women.

The gold standard of treatment for varicose veins of the labia and vulva is foam sclerotherapy. This is an in-office procedure where a specially prepared sclerosant solution is injected into one of the branches of the varicosities using a miniscule needle. The sclerosant solution will destroy the inner lining of the varicose vein and this leads to closure and disappearance of the varicose veins. It is a relatively painless office procedure. However due to to the sensitivity of the area being treated, Dr. Shamma usually asks his nurse apply a local anaesthetic cream on the affected area 20 minutes prior to the procedure. Also, instead of injecting the veins in the labia or vulva directly, Dr. Shamma tries to inject one of their tributaries on the inner thighs which communicates with the labial varicosities. Thus the sclerosing agent is delivered to the labial varicosities without directly injecting into them.

This treatment modality is safe, fast, and effective. It can be safely performed during pregnancy. However, unless the patient is severely embarrassed/modest, of the varicose vein of the labia or if the occurrence is symptomatic, Dr. Shamma recommends deferring the treatment till after delivery since in many cases these varicosities recede or even disappear completely after delivery.

REFERENCES

Franceschi C. Anatomie fonctionnelle et diagnostic des points de fuite bulboclitoridiens chez la femme (point C). J Mal Vasc. 2008;33:42.
Dodd H, Wright HP. Vulval varicose veins in pregnancy. BMJ. 1959;1:831-832.
Van Cleef JF. Traitement des varices vulvaires et pelviennes. Hygie. 2006;29:11.
Ferrero S, Ragni N, Remorgida V. Deep dyspareunia: causes, treatments, and results. Curr Opin Obstet Gynecol. 2008;20:394-399.