Dilated veins on the vagina or vulva often appear during pregnancy. After childbirth, the same veins often regress and disappear as the pressure lessens from the pregnant uterus. The persistence of varicose veins on the vulvar regions, buttocks or inner thighs may suggest pelvic congestion syndrome.
In pelvic congestion syndrome, the internal veins remain dilated and symptoms of chronic pelvic disease persist for greater than 6 months. This is a medical condition and warrants investigation for symptomatic patients. Often, the cause can be found as reflux in the pelvic veins including the ovarian vein or internal iliac vein. It is not an easy condition to diagnose and requires a multi-specialty approach. Any patient with chronic pelvic symptoms, especially in the presence of visible varicose veins in the pelvic region, should seek expert consultation with a vein specialist in collaboration with their gynecologist. With proper diagnosis, the condition can be effectively cured with minimally-invasive treatments.
In patients with co-existing varicose veins on the legs and signs of pelvic congestion syndrome, it is recommended to consider a thorough evaluation before proceeding with vein treatment. Effective vein treatment requires eliminating the most proximal sources (highest point) of reflux, which in certain individuals involve the pelvic veins. A comprehensive evaluation by a vascular surgeon with experience in pelvic venous disease is recommended. Smaller pudendal veins that are without symptoms can be treated without further investigation using sclerotherapy.
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