Vulvovaginal varicosities and pelvic congestion syndrome
- Natasha R Johnson, MD
Natasha R Johnson, MD
- Assistant Professor in Obstetrics, Gynecology and Reproductive Biology
- Harvard Medical School
- Section Editors
- Robert L Barbieri, MD
Robert L Barbieri, MD
- Editor-in-Chief — Obstetrics, Gynecology and Women's Health
- Section Editor — General Gynecology and Female Reproductive Endocrinology
- Kate Macy Ladd Professor of Obstetrics, Gynecology and Reproductive Biology
- Harvard Medical School
- John F Eidt, MD
John F Eidt, MD
- Section Editor — Vascular and Endovascular Surgery
- Professor of Surgery
- University of South Carolina School of Medicine Greenville
- Joseph L Mills, Sr, MD
Joseph L Mills, Sr, MD
- Section Editor — Vascular and Endovascular Surgery
- Professor and Chief
- Division of Vascular Surgery and Endovascular Therapy
- Baylor College of Medicine
- Deborah Levine, MD
Deborah Levine, MD
- Section Editor — Imaging
- Professor of Radiology
- Co-Chief of Ultrasound
- Beth Israel Deaconess Medical Center
The pelvic venous syndromes, which include pelvic congestion syndrome and vulvar varicosities, are poorly understood disorders of the pelvic venous circulations.
- Pelvic congestion syndrome (PCS) is characterized by chronic pelvic discomfort exacerbated by prolonged standing and coitus in women who have periovarian varicosities on imaging studies. The etiology of PCS is unclear and the optimum treatment is uncertain. Development of an evidence-based approach to managing these patients has been limited by the absence of definitive diagnostic criteria.
- Vulvar varicosities result from venous obstruction, increased venous pressure, and venous insufficiency, most commonly during pregnancy. They may be isolated or associated with varices of the lower extremity, and they may occur as part of PCS.
Epidemiology — It is estimated that 4 percent of women have had vulvar varicosities . They usually occur during pregnancy and typically regress spontaneously within six weeks postpartum. They are rare in nulliparous women. When they occur in non-pregnant women, they generally present in the second or third decade of life .
Pathogenesis/pathology — Vulvar varicosities are dilated venous channels that probably develop from a combination of proximal venous obstruction and valvular incompetence, which results in increased venous pressure. Their anatomy has been defined by direct injection and surgical dissection of the varices.
The vascular drainage of the female external genitalia includes the dorsal superficial clitoral, bulbovestibular, profundus clitoral, and posterior labial veins. Because these perineal veins do not have valves, they are susceptible to the development of varices. Up to one-half of vulvar varicosities arise from an incompetent great saphenous vein, which drains the superficial and deep external pudendal veins and posteromedial tributaries.
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- VULVOVAGINAL VARICOSITIES
- Clinical manifestations
- - Differential diagnosis
- - Pregnant women
- - Sclerotherapy
- - Ligation
- - Ablation
- PELVIC CONGESTION SYNDROME
- Epidemiology PCS
- Pathogenesis/pathology PCS
- Diagnosis and diagnostic evaluation PCS
- - Clinical manifestations PCS
- - Physical examination PCS
- - Imaging PCS
- Computed tomography and magnetic resonance imaging
- - Laparoscopy PCS
- Differential diagnosis
- Management of PCS
- - PCS without vulvar varices
- - PCS with vulvar varices
- SUMMARY AND RECOMMENDATIONS