Vulvar Varices

Abstract

Varicose veins in the vulvar and perivulvar area are seen in 4% of women. Most of them are secondary to pregnancy and usually regress spontaneously. Vulvar varicose veins are rare in nonpregnant women. When present, they can be seen alone, associated with leg varices or associated with venous malformations of the labia, clitoral area, or vagina with or without arteriovenous malformations on the limbs or trunk (Klippel-Trenaunay-Weber syndrome and Parkes-Weber syndrome). In some cases, vulvar varices are seen as part of the so-called "pelvic congestion syndrome." Clinically, vulvar varices may present as small isolated protrusions, mainly in the labia majora, or as large masses, involving the vulva and even the perivulvar area. The treatment of choice of vulvar varices seen during pregnancy is conservative and symptomatic. Surgical pathologists need to be aware of the existence of vulvar varicose veins and its possible presence in biopsy specimens. Vulvar varicose veins can be misdiagnosed clinically as cysts or masses mainly in the Bartholin gland area. Correct diagnosis of the lesion is important to determine appropriate therapy and to recognize the possibility of associated anatomical or pathological problems.

Successful embolization of vulval varices arising from the external pudendal vein

“…Varicose veins in the vulvar and peri-vulvar area are seen in 4% of women [1]. Varicose veins of the vulva are most commonly seen during pregnancy.…”

Vulvar varicosities: diagnosis, treatment, and prevention

“…During the postpartum period, perineal veins may persist and enlarge with time in 4%–8% of patients 2,3. Vulvar varicosities are associated with venous thromboembolic events, both during pregnancy and in the nonpregnant state, superficial dyspareunia, and vulvodynia.…”

Isolated large vulvar varicose veins in a non-pregnant woman

“…It is estimated that 4% of women have had vulvar varicosities (VV). 1 , 2 They may be isolated or associated with varices of the lower extremity, and they may occur as part of pelvic congestion syndrome (PCS). When symptomatic women may complain of discomfort, swelling, or pressure in the vulval area especially with prolonged standing, at the end of the day, during or after intercourse (dyspareunia), or just before the onset of menses, however, they are often asymptomatic.…”

“…When symptomatic women may complain of discomfort, swelling, or pressure in the vulval area especially with prolonged standing, at the end of the day, during or after intercourse (dyspareunia), or just before the onset of menses, however, they are often asymptomatic. 1 – 3 In pregnant women, diagnosis by physical examination is possible as the varices are engorged and clinically visible. To plan the best therapeutic approach, investigations are needed to determine whether the varices are isolated or caused by other venous connections like pelvic or lower limb venous system.…”