Perineal and vulval varicose veins
(Pelvic varicose veins)
Perineal and vulval varicose veins are located respectively in the “labia majora” and the perineum.
These varicose veins generally appear after the 5th month of pregnancy. They are asymptomatic during pregnancy and are only treated if they persist 3 - 4 months after giving birth.
Pelvic varicose veins (perineal and vulval varicose veins) are unfortunately overlooked through embarrassment or due to a lack of thorough examination while standing.
One cause of perineal and vulval varicose veins: high pelvic pressure
Perineal and vulval varicose veins can be a part of a history of pelvic hyper-pressure. This increase in pressure in the true pelvis (ovarian and uterine veins) can be due to:
- a tumor (a uterine fibroma or ovarian cyst) which must always be subject to research by clinical examination and a gynecological ultrasound scan.
Pelvic hypertension can be externalized through the various connections between the true pelvis and the perineum: :
- either through the vagina and vulva
- through the anus (hemorrhoids)
- or through the inguinal orifice, or more rarely, the obturator orifice
Pelvic varicose veins can be spontaneously painful, either during periods or intercourse.
Perineal and vulval varicose veins should be systematically checked for when examining any female patient with varicose veins of the lower limbs: in a standing position, with the legs slightly parted, the patient is asked to cough or push. It is frequently these involved when previously operated or sclerosed varicose veins recur.
Treatment of perineal and vulval varicose veins is simple
Surgical treatment of perineal and vulval varicose veins is the only way to electively seal the points of leakage and connection with the true pelvis.
These leakage points are deep and completely separate. As is always the case in modern varicose vein surgery, these are located pre-operatively using location mapping and are marked in marker pen.
Operating on perineal and vulval varicose veins
Perineal and vulval varicose veins operations will always be mini-invasive under local tumescent anesthesia under surgical conditions and without hospitalization.
Surgery on pelvic varicose veins is practiced through 1mm micro-incisions, closed using Steristrips.
Sometimes it is necessary to close the deep orifice between the muscles of the perineum, but still using local anesthesia and located by a specialist angiologist used to this technique.
Surgery on perineal and vulval varicose veins causes little pain but is followed by an ecchymosis which is re-absorbed in a few days without leaving a trace.
Surgery on varicose veins must always be performed by a vascular surgeon specializing in varicose vein surgery, so that they can best offer you all available techniques (sclerotherapy and mini-invasive surgery) which are often complementary.
Mini-invasive surgery on perineal and vulval varicose veins should always be performed at the same time as operations on varicose veins of the lower limbs, which effectively avoids recurrences.
Read on: Varicose veins of the feet
Traitement et operation des varices