Vulval Varicose Veins - Diagnosis

How are vaginal varicose veins and vulval varicose veins diagnosed?

Before the vaginal varicose veins or vulval varicose veins can be treated, the underlying cause of them has to be identified.

The underlying cause in the vast majority of vaginal varicose veins or vulval varicose veins is reflux in the pelvic veins. Pelvic vein reflux can be caused by ovarian vein reflux or internal iliac vein reflux or combination of both. It is essential to know which of the veins is affected and causing the problem to know how to treat the patient.

In the past, radiologists have performed CT scans or MRI scans of the pelvis to identify the problem. Although CT and MRI are used to show pelvic varicose veins, they are not particularly good at showing reflux in the veins and are therefore not accurate in identifying which of the two ovarian veins or two internal iliac veins are involved. Similarly, venography, where contrast is put into the veins and x-rays taken, is a non-physiological examination and does not always show the way blood behaves in the real patient.

The best investigation for this condition is transvaginal duplex ultrasonography. Unfortunately this is a very difficult investigation to be expert in, and to get accurate results, very specialist training is required with a lot of experience. It is not something that can be taken up by people who only perform it occasionally.

When performed by an expert who is performing transvaginal scans regularly every week, the transvaginal duplex ultrasound scan can identify not only the reflux in the vaginal varicose veins and vulval varicose veins, but also which of the four pelvic veins is causing the problem. Of the four pelvic veins (two ovarian veins and two internal iliac veins), any number of them may be involved.
 
This table shows how doctors grade vulval varicose veins:
 
 
Description
Frequency seen at present
Grade 0
Normal – no varicosities nor venous reflux in vulva
Usual
Grade 1
No visible varicosities in vulva, but ultrasound proven reflux in vulval veins usually with para-vulval varicose veins seen on inner thigh
Common – 1 in 7 females presenting with leg varicose veins (1 in 5 of those post vaginal delivery)
Grade 2
Visible varicosities seen through mucosa of inner labia and lower vagina and ultrasound proven reflux in vulval veins.
Uncommon
Grade 3
Isolated varicosities seen on standing through skin of outer labia majora without a distortion of the general anatomy of the area
Very uncommon
Grade 4
Extensive varicosities of the labia, distorting skin and distorting the gross anatomy of the area on standing
Rare

Table of The Whiteley Clinic grading system used for Varicose Veins of the Vulva. The assessment is made in a non-pregnant state and when standing. Frequency may be underestimated as this has been assessed on those finding that something can be done, despite the usual advice to the contrary.

(published in “The treatment of varicose veins of the vulva and vagina.” MS Whiteley In: Greenhalgh RM (Ed.) Vascular and Endovascular Controversies Update. London Biba Publishing, 2012 p. 666-670)

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This website was last updated on 03/10/17.

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