|Year : 2016 | Volume
| Issue : 1 | Page : 44-45
Vulvar varicosities in pregnancy
Matthew Chum Taingson, Joel A Adze, Stephen B Bature, Durosinlorun M Amina, Mohammed Caleb, Abubakar Amina
Department of Obstetrics and Gynaecology, Faculty of Medicine, Barau Dikko Teaching Hospital, Kaduna State University, Kaduna, Nigeria
|Date of Web Publication||6-Sep-2016|
Matthew Chum Taingson
Department of Obstetrics and Gynaecology, Faculty of Medicine, Barau Dikko Teaching Hospital, Kaduna State University, Kaduna
Source of Support: None, Conflict of Interest: None
| Abstract|| |
A case of vulval varicosities occurring during pregnancy that was managed conservatively and regressed completely postpartum is presented.
Keywords: Conservative management, pregnancy, vulval varicosities
|How to cite this article:|
Taingson MC, Adze JA, Bature SB, Amina DM, Caleb M, Amina A. Vulvar varicosities in pregnancy. Ann Nigerian Med 2016;10:44-5
| Introduction|| |
Vulval varicosity is a distressing disorder occurring in 10% of pregnant women, especially during the latter half of pregnancy and usually regresses postpartum. Women become extremely uncomfortable because of the bulk, tension, and warmth of one or both labia majora, especially in the posterior part. The mass is an embarrassment and causes discomfort during sitting and walking.
| Case Report|| |
Mrs. AH was a 28-year-old G4P3+0 3alive, who presented to the Antenatal Clinic of Barau Dikko Teaching Hospital Kaduna, on October 13, 2015. Her last menstrual period was March 20, 2015 (Gestation 29 weeks 2 days). She complained of vulval lesions of 2 months duration. The progression was gradual. Mild itching and heaviness were the associated symptoms. There was a history of similar swellings during her last pregnancy (2013). She had three previous deliveries without complications. She had no menstrual problems; she was a house wife with no formal education.
On examination, she was not pale, anicteric, had no pedal edema. Her chest was clinically clear. Her pulse rate was 80 beats/min, and blood pressure was 120/80 mmHg. In the abdomen, there was no organomegaly, and the uterine fundus was consistent with 30 weeks gestation. Genital examination revealed tortuous, soft nontender, compressible swellings bilaterally over the external surface of the labia majora [Figure 1]. Varicose veins were seen over the right thigh [Figure 2]. The patient was managed conservatively with the use of tights and stocking which she wore in the mornings before she got out of bed. She was counseled also to avoid standing for long. The lesions regressed completely within 2 months postpartum.
| Discussion|| |
Vulvar varicosities most commonly occur during pregnancy and create a great deal of anxiety in pregnant patients. They may produce pelvic discomfort, vulvar pressure, pruritus, and a sensation of prolapse. Vulvar varicosities may appear suddenly by the middle of the first pregnancy, and tend to occur more frequently in the second or subsequent pregnancies because of their tendency to enlarge. Our patient gave a history of similar swellings during her last pregnancy. They may also occur in nonpregnant patients as part of the “nutcracker phenomenon” which is the compression of the left renal vein between the aorta and superior mesenteric artery. Vulvar varices may occur as part of pelvic venous congestion syndrome due to venous reflux through the left ovarian veins.
Diagnosis is usually clinical, with dilated tortuous veins seen, and is partially compressible and have a “bag of worms feel” on palpation usually on the labia majora, minora, and vagina. Other differentials such as lymphangioma and isolated neurofibroma, should be entertained. Biopsy of the lesion is unwarranted, and massive hemorrhage is an associated complication. Our patient, in addition, had varicose veins over the right thigh. Doppler sonography with deep inspiration and expiration is the preferred method of investigation. This was not available in our center at the time of presentation.
Conservative therapy is the most common treatment modality as vulvar varices usually disappear postpartum. Special compression garment “V2” supporter or the V-Brace, can be used also in the management. Sclerotherapy is rarely used, mostly in cases of extensive vulvar varices that may rupture during labor. Women in which the varices persist, after delivery and have symptoms such as chronic pelvic pain, dyspareunia, dysuria, lumbosacral neuropathy and generalized lethargy, are often treated with form Sclerotherapy, and coiling of the ovarian veins.
This case report highlights the importance of genital examination to diagnose vulvar varicosities in pregnancy and efficacy of conservative management.
The authors would like to express gratitude to Prof Lydia Airede, for her critical reading and comments on the case report.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Jindal S, Dedhia A, Tambe S, Jerajani H. Vulvovaginal varicosities: An uncommon sight in a dermatology clinic. Indian J Dermatol 2014;59:210.
Dodd H, Wright HP. Vulval varicose veins in pregnancy. Br Med J 1959;1:831-2.
Hokama A, Oshiro Y. Clinical vistas: A thin 43-year-old woman with gross hematuria. CMAJ 2005;173:251.
Lewis FM, Lewis-Jones MS, Toon PG, Rollason TP. Neurofibromatosis of the vulva. Br J Dermatol 1992;127:540-1.
Shiva Kumar V, Madhvamurthy P. Vulval varicosities in pregnancy. Indian J Dermatol Venereol Leprol 1999;65:147-8.
Gandini R, Chiocchi M, Konda D, Pampana E, Fabiano S, Simonetti G. Transcatheter foam sclerotherapy of symptomatic female varicocele with sodium-tetradecyl-sulfate foam. Cardiovasc Intervent Radiol 2008;31:778-84.
Kwon SH, Oh JH, Ko KR, Park HC, Huh JY. Transcatheter ovarian vein embolization using coils for the treatment of pelvic congestion syndrome. Cardiovasc Intervent Radiol 2007;30:655-61.
[Figure 1], [Figure 2]