The first way to diagnose this problem is by simply looking. Usually there is a history of Vulval Varicose veins in pregnancy. Looking at the top of the thigh, there is a Tendon called the Adductor Longus tendon.
This can be easily felt in everyone – it feels hard and like a tube to the touch. If the veins arise in front of this tendon, then they almost always come from the veins in the legs – these are NORMAL varicose veins.
If the veins arise behind this tendon (see picture on right), on the inside of the thigh – or running down the back of the leg, then they are almost always coming from Ovarian or Pelvic veins reflux. These veins cannot be treated by traditional methods of varicose vein surgery.
When ovarian or pelvic vein reflux is suspected, or vulval varicose veins have been seen, or when varicose veins appear in the legs behind the Adductor Longus tendon, a specialised Ultrasound examination is required.
The veins in the pelvis cannot be seen easily by ultrasound across the abdomen – as they are too deep.
Therefore, we use a special ultrasound probe that can see the veins through the vagina.
Our specialist female vascular scientists perform this test and can check if there are varicose veins in the pelvis – and if there are – where they are coming from.
Although most do come from the ovarian veins (as described before) there are other veins in the female pelvis that can also cause the same thing – the internal iliac veins.
The scientists can show the patient what is happening as they carry out the scan – and then they write a detailed report so that the consultants can try to plan appropriate treatment.
These problems can all be cured using the techniques that we have developed at The Whiteley Clinic.
The ovaries are the female gonad – the equivalent to the male testicle. Before birth the ovaries grow in the same place in the foetus – up by the kidney. As the baby girl develops, the ovaries move down into the pelvis – taking their veins – the ovarian veins – with them.
This is identical to the male – with the sole exception that the ovaries stay inside the pelvis and do not continue to the outside, as the testicles do.
Not surprisingly, the ovarian veins can go wrong just as the testicular veins can.
In exactly the same way, if the valves in the ovarian vein give up working, a “varicocele” is formed around the ovary.
Again, not surprisingly the swollen veins in the pelvis can cause aching and a “dragging” feeling, especially during a period – just as a variocele around a testicle can cause symptoms.
However, there are 2 main differences in women:
Firstly, the veins can spread further in the pelvis, pushing on the bladder and bowel and irritating them.
Secondly, as they are on the inside and therefore invisible to doctors, they are usually ignored by doctors and patients alike – the symptoms being put down to “women’s problems”.
Whenever medical people need to communicate with each other or decide on treatments, it is very useful to have a recognise grading scale for the condition.
Before 2012, there was no clinical grading scale in use for Vaginal and Vulval Varicose Veins.
In early 2012, the following grading scale was published by The Whiteley Clinic, and is now used to classify the severity of any patients presenting with varicose veins of vulva:
| Grade | Description | Frequency seen at present |
|---|---|---|
| 0 | Normal – no varicosities nor venous reflux in vulva | Usual |
| 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) |
| 2 | Visible varicosities seen through mucosa of inner labia and lower vagina and ultrasound proven reflux in vulval veins. | Uncommon |
| 3 | Isolated varicosities seen on standing through skin of outer labia majora without a distortion of the general anatomy of the area | Very uncommon |
| 4 | Extensive varicosities of the labia, distorting skin and distorting the gross anatomy of the area on standing | Rare |
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