Such studies were performed in 17 patients with painful varicose veins of the pelvis. In the event of enlargement or valvular incompetence of ovarian veins, signs of pelvic venous congestion (eg, chronic pelvic pain, dyspareunia, dysmenorrhea) 5 or scheduled surgery on the ovarian veins, patients underwent multislice computed tomography (MSCT) or selective ovariography with pelvic phlebography (SOPP) to verify the diagnosis, clarify the anatomical features of the pelvic veins, assess the state of the internal iliac vein tributaries, and to exclude or verify the mesoaortic compression of the left renal vein or left common iliac vein. Modified pain-intensity and individual pain-tolerance scale.įurther examination of patients was dependent on the results of the duplex ultrasound. The aim of this prospective study was to describe our observations of this condition and to develop a diagnostic and therapeutic approach to vulvar varicosities in various clinical settings. There is a paucity of information in the medical literature on the diagnosis and management of vulvar varicosities. Only a reduction in blood flow in the tributaries of the internal iliac vein will lead to the elimination of pelviperineal venous reflux and the disappearance of vulvar varicosity. It is clear from a review of these anatomical connections that surgery on ovarian veins (resection, embolization) will have no effect on the dilated vulvar veins. In addition, the connection to the pelvic veins is provided via the obturator vein and superficial circumflex iliac vein, as well as the groin, clitoral, and perineal perforant veins. The veins of the labia majora and labia minora anastomose with the uterovaginal plexus. 4 Vulvar veins drain into the external and internal pudendal veins, which deliver blood to the great saphenous vein and internal iliac vein. The anatomical basis for the development of vulvar varicosities relates to the connections between the veins of the pelvis and external genitals. It is difficult to estimate reliably the prevalence of this pathological condition, as vulvar varicosities often remain undiagnosed because of the atypical localization of the varicose veins, women’s reluctance to consult, and in some cases the absence of any discomfort. They may also cause psychoemotional and family problems. 2, 3 Vulvar varicosities are associated with venous thromboembolic events, both during pregnancy and in the nonpregnant state, superficial dyspareunia, and vulvodynia. 2 During the postpartum period, perineal veins may persist and enlarge with time in 4%–8% of patients. Vulvar varicosities, or varicose veins of the vulva, 1 are dilated veins in the labia majora and labia minora, and are estimated to occur in 22%–34% of women with varicose veins of the pelvis and in 18%–22% of pregnant women.

Ultrasound for varicose veins