[Vulvar varices]

Abstract

Vulval or vulvoperineal varicose veins generally appear in the course of child-bearing under the influence of hormonal impregnation on susceptible terrain. The vulval venous network is drained by the external pudendal veins, collateral with the internal saphenous veins, and by the internal pudendal veins affluent from the internal iliacs. Hormonal influence appears to play a major role in associating estrogen, progesterone, gonadotropin and corticosteroids, which have a lytic action on elastic tissues during motherhood. In the course of pregnancy, functional symptomatology is generally visible from the fifth month. The varices located at the vulva are generally unilateral, and gradually become congestive, appearing as purple protrusions of a soft consistency. After delivery, they are attenuated without usually totally disappearing. Outside pregnancy, clinical manifestations are less frequent and vulvoperineal varices are only revealed by close clinical examination. They are often the causal factor for reflux which, regardless of whether it is associated with incontinence of the saphenous trunks, provokes varicose dilatation of the lower limbs. Differential diagnosis is performed with the post-phlebitic syndrome. Doppler echography allows any participation of the deep venous trunks to be ruled out. Phlebography is reserved for severe angiomatous dilatations of the vulval region. In the non-pregnant patient, treatment consists of sclerotherapy, surgery being reserved for cases refractory to this method. In our direct experience with 386 cases, only 85 females presented isolated vulvoperitoneal varices. Of the 83 patients, treated by sclerotherapy, 63% of the cases have shown no recurrence within the subsequent three years.