Vaginal Varices - Symptoms and Management

Introduction

Vaginal varices, also called vulvar varicosities or vaginal veins, are a medical condition that affects women most likely during the gestational tenure or as a result of increased stress over the veins of the pelvis. While they may not be as common as other venous disorders, vaginal varices are equally painful and cause discomfort.

What Is the Cause of Vaginal Varices?

Vaginal varices are primarily caused by the engagement of veins in the vulvar and vaginal region. This enlargement can be because of several factors, including-

• Pregnancy - One of the most common causes of vaginal varices is pregnancy. As the uterus enlarges to make space for the baby, it exerts pressure on the pelvic veins, which can pave the way to the development of varicose veins in the vaginal area. These veins may become more prominent as the pregnancy progresses.

• Hormonal Changes - Hormonal fluctuation, particularly the elevated levels of progesterone during pregnancy, can weaken the vein walls, making them more prone to dilation and formation of varices.

• Genetics - Women may be genetically predisposed to developing this condition. A family history of varicose veins can increase the risk.

• Obesity - Having an increased BMI or being obese can contribute to increased pressure on the pelvic veins, making it more likely for varices to develop in the vaginal area.

• Chronic Constipation - Straining during bowel movements due to chronic constipation can raise intra-abdominal pressure, potentially leading to the development of vaginal varices.

What Are the Symptoms of Vaginal Varices?

Vaginal varices can cause a range of symptoms that vary in severity from one individual to another. Common symptoms include:

• Pain or Discomfort - Women with vaginal varices often experience a dull aching pain in the vulvar or vaginal area. This discomfort can worsen during and after physical activities or even after a prolonged period of standing.

• Visible Veins - Vaginal varices may appear as swollen, twisted, or enlarged veins around the vulva, vaginal opening, or inner thighs. These veins can be blue or purple.

• Itching or Burning Sensation - Some women with vaginal varices may experience itching or a burning sensation in the affected area.

• Pain During Intercourse - Engaging in sexual intercourse may become painful for women with vaginal varices due to the increased pressure on the veins during this activity.

• Swelling - Swelling of the vulvar area can occur, which may become more noticeable as the day progresses.

• Worsening Symptoms With Pregnancy - The condition occurs due to stress on vaginal tissues, and symptoms often become more pronounced as the pregnancy advances.

How Are Vaginal Varices Diagnosed?

A healthcare professional, often a gynecologist or vascular specialist, typically conducts the diagnosis. The diagnosis can be achieved by:

• The diagnostic process always begins with the medical history, asking questions regarding the onset, type, and severity of the discomfort, along with other medical ailments.

• A comprehensive physical examination helps in diagnosis, which includes the visual inspection, which often reveals swollen, twisted, or enlarged veins in the vaginal area that may be blue or purple; after that, gentle application is performed in the affected area to assess the tenderness and fullness of veins.

• In many cases, a color Doppler ultrasound may be recommended to assess the blood flow and extent of the condition.

• A pelvic ultrasound may also be conducted to evaluate the overall pelvis region due to the relationship between the pelvis and adjacent areas.

• In some cases, an intravaginal USG (ultrasound) may be performed to examine the varices closer.

• Other tests, such as CT (computed tomography) scans and blood tests, may also be ordered depending on the individual cases.

The diagnosis of the vaginal varices involves a combination of all factors to conclude. An early diagnosis and determining the most appropriate treatment plan based on the individual's unique circumstances may help the patient eliminate this condition.

How to Prevent Vaginal Varices?

The preventive management of vaginal varices depends on the severity of symptoms and the underlying causes. In many patients, conservative approaches are-

1. Compression Garments - Wearing compression stockings or supportive garments can help minimize the swelling and discomfort associated with this condition.

2. Elevating the Legs - Elevating the legs while resting can improve blood flow and decrease the pressure on the pelvic veins.

3. Regular Exercise - Engaging in low-impact exercises, such as swimming or walking, can improve overall circulation and help manage symptoms.

4. Pelvic Floor Exercise - Performing pelvic floor exercises can help increase the muscle tone in the pelvic region, which can minimize some of the discomfort associated with vaginal varices.

5. Pain Relief Medications - Over-the-counter pain relievers like Acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) can help manage pain and discomfort.

6. Preventive Management - While it may not be possible to prevent the vaginal varices entirely, certain measures can help reduce the risk and minimize the symptoms.

• Avoiding obesity and maintaining a healthy weight, along with regular, low-impact exercise, will promote healthy blood circulation and reduce pelvic pressure.

• Prolonged standing should be accompanied by short breaks of leg elevation, which will result in improved blood flow.

• Drinking enough water is good for vascular health and prevents the vaginal varices.

What Is the Management for Vaginal Varices?

For cases where no improvement to conservative treatment is seen, medical interventions may be necessary-

• Sclerotherapy - This procedure involves the injection of a special solution into the areas that have been affected, causing them to shrink and gradually fade from view.

• Endovenous Laser Treatment (EVLT) - This procedure utilizes laser energy to seal off the problematic veins, redirecting blood flow to healthier vessels.

• Surgical Ligation - In rare cases, surgical ligation of vein stripping may be considered to remove or tie off the affected veins.

• Minimally Invasive Procedures - Some newer minimally invasive techniques, such as radiofrequency closure or glue closure, can effectively treat vaginal varices with minimal scarring and downtime.

• Drugs - Venotonic drugs such as micronized purified flavonoid fraction (MPFF) are commonly preferred during pregnancies, especially used in the second trimester.

• Surgical Treatment - Emergency surgical crossectomy is done for patients with complications such as thrombophlebitis or ostial thrombophlebitis occurring in the vulvar veins.

• Anticoagulant Therapy - Anticoagulants like low molecular weight heparin are administered at intermediate doses.

• Coil Embolization - Resection of the ovarian veins reduces venous congestion in the pelvis and minimizes the formation of vulval varices.

Conclusion

Vaginal varices are a relatively less common condition but result in pain and discomfort, especially during pregnancy. While they are not typically a serious medical concern, they can affect a woman's quality of life. In case of any of the symptoms of vaginal varices, concerned women should promptly see a specialist and start the early treatment.