Vulvar Varicose Veins

Yongky G+., Arditya Y+., Hidayat N. A++

Widya Mandala Catholic University, Faculty of Medicine
++
Departement of Thorax and Cardiovascular Surgery. Airlangga General Hospital, Airlangga University, Surabaya,
East Java

Background
Vulvar varices are found on the labia majora and minora. Usually, they
develop during month 5 of a second pregnancy. They occur in 10% of
pregnant women. Out of embarrassment, women rarely mention vulvar
veins, which in addition are not adequately sought in the physical
examination with the woman in the standing position during month 6 of
pregnancy and the first month after delivery. Most often they are
asymptomatic.

Case Presentation
History a female ...years old was diagnose vulvar varicose veins. This is a....pregnancy and
....month of pregnancy. The complain from patient is........
Physical examination.........
Diagnose using clinical exemination. In laboratory test we using selective venography
Treatment we using the Sclerotherapy, this is the preferred method because it is
very effective on these thin-walled varices

Discussion
Vulvar veins have communicating branches and anastomoses between
the pelvic wall and the veins of internal organs, between the internal and
external iliac venous system, and with the circulation of the medial aspect of
the thigh via the perineal veins. Vulvar varices are not caused by an increase
in circulatory volume during pregnancy, but by increased levels of estrogen
and progesterone. Vulvar veins are the target of these hormones. It should
be kept in mind that pregnancy is a risk factor for venous thrombosis, The
risk increases with the number of pregnancy. In rare cases, they cause
anxiety, pain, and manifest as heaviness, discomfort during walking,
dyspareunia, and pruritus.
Clinical examination of the patient standing and then supine reveals
the following: soft, bluish dilatations, depressible by digital examination, with
no painful point (sign of thrombosis). The diagnosis of vulvar varices is
clinical. Laboratory tests are requested to look for a cause other than
pregnancy, in case of a complication or to look for leakage sites. Large or
symptomatic varices are managed with curative therapy. Varices in the groin
or the mons veneris can be treated with echosclerosis. Care should be taken
to avoid the external pudendal artery for which an accidental injection
produces disastrous lesions in the vascular area downstream.