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Genital varicose veins: why they can appear during pregnancy and how to treat them

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Varicose veins in the lower limbs are a very common problem in the population, especially in women. They have a double component: pain and aesthetic. It is also common for varicose veins to appear in the genital region in isolation (vulvo-vaginal varicose veins) or be associated with varicose veins in the legs. The main cause of the appearance of genital varicose veins is pelvic venous insufficiency, that is, varicose veins in the pelvis.

The increase in venous pressure and the insufficiency of the pelvic veins cause leaks or reflux to the genital region and legs, developing visible varicose veins in these areas. These vulvar or genital varicose veins are very related to pregnancy and its anatomical and hormonal changes, which frequently appear during it.

In some cases they usually subside later, although this fact greatly determines the subsequent appearance of new episodes of this type of varicose veins. It is also common that in women with several pregnancies, varicose veins can persist indefinitely after births.

Vulvar varicose veins transcend in many aspects, significantly impacting the quality of life. Women who suffer from them often report that varicose veins affect their self-esteem. Can produce genital heavinesseven severe discomfort or pain during or after sexual relations and these discomforts can intensify during the summer or during the menstrual period. They are also usually associated with varicose veins in the legs and recurrent low back pain.

Therefore, timely diagnosis and treatment greatly improves the quality of life of patients with pelvic congestion syndrome.

Diagnosis and treatment

The first thing to do if you develop varicose veins in the genitals is to consult a doctor. professional specialist in vascular surgery. When genital varicose veins occur during pregnancy, gynecologists play a relevant role since they will have the first diagnostic suspicion and must subsequently be referred to the vascular surgery service for a clinical evaluation, indicate support measures to prevent complications and perform the procedure. respective follow-up.

After childbirth, a complete clinical and ultrasound study and it is recommended to perform transvaginal, abdominal and lower limb Doppler ultrasound in order to identify the presence of varicose veins in the pelvis, venous compressions and their leaks. Imaging diagnostic techniques (CT-Angio and MR-Angio) can also be very useful in the evaluation of this pathology.

If pelvic varicose veins are confirmed sonographically, coupled with the presence of chronic pelvic pain and other clinical manifestations such as varicose veins in the genitals, varicose veins in the legs, lower back pain, discomfort or pain related to the sexual act, it is indicated to perform a pelvic phlebography.

It’s a diagnostic and therapeutic study which is performed by accessing through a vein in the arm, introducing a catheter until reaching the veins of the pelvis and thus allows us to visualize and identify if there are pelvic varicose veins or venous compressions in the left iliac vein (May-Thurner syndrome) or in the left renal vein (Nutcracker syndrome). At that same moment, embolization can be performed, which is the programmed occlusion of the pelvic varicose veins.

In the case of venous compressions, the treatment consists of implant a stent that performs the function of a spring for prevent the vein from being compressed by the structures that clamp it. Subsequently, it is essential to perform clinical and ultrasound follow-up.

Once the treatment of pelvic varicose veins has been carried out and the genital area has been decongested, the next step to perform is sclerotherapy (minimally invasive procedure) of vulvar varicose veins, seeking to achieve a good aesthetic result.

These types of treatments require professionals with extensive experience for the diagnosis, treatment and monitoring of this pathology. The Angiology and Vascular Surgery unit at Hospital Ruber Internacional has a multidisciplinary team of specialists in vascular surgery, interventional radiology and vascular aesthetics.

*Dr. Pablo Gallo is head of the Angiology and Vascular Surgery Unit at the Ruber International Hospital; and Dr. Santiago Zubicoa, head of the Interventional Vascular Radiology Unit of the same hospital center.

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