Vulval varices, reported in 5% to 10% of pregnancies, may appear
suddenly by the second month of pregnancy. They tend to occur
more frequently from the second pregnancy onwards and are generally
asymptomatic. However, they may be accompanied by vulval heaviness,
pruritus or burning.
These varices may be supplied in three different ways:
an incompetent long saphenous arch, via a superficial external
pudendal branch;
the internal iliac vein, via internal pudendal veins or uterine
and vaginal veins;
left or right ovarian veins.
Vulval varices supplied by ovarian veins have been studied
in particular detail by selective phlebography. The right
ovarian vein drains directly into the inferior vena cava several
centimetres below the anastomosis of the right renal vein.
The left ovarian vein drains into the ipsilateral renal vein,
which lies between the aorta and the superior mesenteric artery,
before joining the inferior vena cava. This particular configuration
explains why, in the standing position, due to the weight
of the small intestine, the superior mesenteric artery compresses
the left renal vein, resulting in stasis or even the development
of a countercurrent circulation in the left ovarian vein.
This phenomenon is further accentuated during pregnancy. Drainage
via the right ovarian vein develops in order to compensate
for the interference to drainage of uterine venous blood by
the left ovarian vein. The overload on the right ovarian vein
is reflected by filling of the vulval varices.
Further reading
Bergan J.J., Yao J. Venous disorders, W.B. Saunders Company, 1991.
Varices vulvaires
Dixon J.A., Mitchell W.A. Venographic and surgical observations in vulval varicose
veins. Surg Gynecol Obst, 1970, 131
458-64.
Lechter A.,
Alvarey A., Lopez G. Pelvic varices and gonadal
veins. Phlebolo , 1989, 2: 181-8.
Varices fessières
Lefebvre D., Bastide G., Vaysse Ph., Roux R., Joly R. Connexions veineuses
intra et extrapelviennes. Étude anatomique. Phlébologie,
1989, 42: 385-9.
Van Der Stricht
J., Van Oppens C. Where do vulvar varices come from ? Phlébologie 89,
J.
Libbey Eurotext, 1989 473-5.
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