GENITAL-VAGINAL VARICES

 

Genital-vaginal varices are enlarged vessels that occur as a result of pelvic vein insufficiency in the vulva, vagina and groin in women, and around the testis and groin in men. These varices are seen especially in women who have given birth and are more common in the Asia, Middle East and Africa than in western countries. The main cause of varicose veins in the genital area is the failure of some veins in the lower abdomen called pelvis. This failure is most commonly seen in the left gonadal vein and right iliac vein, and less frequently in other vessels in this region. As a result of venous insufficiency in these vessels, venous blood, which should normally flow into the lung, accumulates in the testis in men, ovaries and vagina in women and causes varices in these areas. These varices may then extend from the inner groin to the leg and can reach down to the feet.

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Genital-vaginal varices are common varicose veins, but generally undiagnosed and treated poorly. The presence of varicose veins in the genital area and a history of pain in the legs during menstrual bleeding in women are typical findings and should rise the suspicion for pelvic vein incompetence. The most important method in diagnosis is color Doppler ultrasound, but it must be performed by experienced physicians who are familiar with this disease. Pelvic vein insufficiency and genital varices often connect with the great saphenous vein, leading to "secondary" saphenous vein failure after some time. In practice, a significant proportion of patients thought to have great saphenous vein insufficiency are actually "secondary" great saphenous vein insufficiency due to pelvic vein incompetence. In such patients, treatment of saphenous vein insufficiency is not sufficient, pelvic insufficiency and genital varices should also be treated, otherwise recurrence may occur in a short time.

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In the treatment of genital-vaginal varices, the underlying venous insufficiency should be treated first. If the patient has left gonadal vein insufficiency, the left gonadal vein should be closed using coils, glue and foam with an angiography intervention (embolization). Varicose varices in the vagina and vulva should be treated with ultrasound guided foam sclerotherapy. Most of the varices in this area are invisible to the naked eye. For this reason, sclerotherapy must be performed carefully under ultrasound guidance. If the patient additionally has venous insufficiency and varicose veins in the legs, these should also be treated with laser, foam and miniflebectomy.