Question: Are there any effective evidence-based treatments for vulval/vulvar varicosities that have persisted for many years post-pregnancy?
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Answer: A Cochrane review (Bamigboye) for interventions for varicose veins and leg oedema in pregnancy notes that for the majority of women, varicose veins subside on their own within three or four months of the baby's birth. Any corrective treatment is often deferred to after this period. However, there was not enough evidence on treatments for varicose veins and leg oedema in pregnancy:
"Rutosides appear to help relieve the symptoms of varicose veins in late pregnancy. However, this finding is based on one small study (69 women) and there are not enough data presented in the study to assess its safety in pregnancy. It therefore cannot be routinely recommended. Reflexology appears to help improve symptoms for women with leg oedema, but again this is based on one small study (43 women). External compression stockings do not appear to have any advantages in reducing oedema. "
9 case reports of vulval varicosities in non-pregnant women were identified. 6 were managed surgically, (Bell, Fliegner, Leung and Royle) and 3 were treated by sclerotherapy (Ninia)
(Evidence level III)
One article on post-partum persisting pudendal varicose veins was identified (Rasmussen), but no further details were available.
References:
- Bamigboye AA, Smyth RMD. Interventions for varicose veins and leg oedema in pregnancy. Cochrane Database of Systematic Reviews 2007, Issue 1. Art. No.: CD001066. DOI: 10.1002/14651858.CD001066.pub2.
- Bell D. Kane PB. Liang S. Conway C. Tornos C. Vulvar varices: an uncommon entity in surgical pathology. International Journal of Gynecological Pathology. 26(1):99-101, 2007 Jan. Abstract
- Fliegner JR. Vulval varicosities and labial reduction. Australian & New Zealand Journal of Obstetrics & Gynaecology. 37(1):129-30, 1997 Feb. Abstract
- Leung SW. Leung PL. Yuen PM. Rogers MS. Isolated vulval varicosity in the non-pregnant state: a case report with review of the treatment options. [Review] [11 refs] Australian & New Zealand Journal of Obstetrics & Gynaecology. 45(3):254-6, 2005 Jun.
- Ninia JG. Goldberg TL. Treatment of vulvar varicosities by injection-compression sclerotherapy and a pelvic supporter. Obstetrics & Gynecology. 87(5 Pt 1):786-8, 1996 May. Abstract
- Rasmussen OO. Hamilton Jakobsen B. Post-partum persisting pudendal varicose veins--effect of local excision. Vasa. 16(4):352-3, 1987.
- Royle JP. Macafee CA. Beischer NA. An unusual presentation of varicose veins of the vulva. Australian & New Zealand Journal of Obstetrics & Gynaecology. 11(2):122-5, 1971 May.
Search date: October 2010
Classification of evidence levels
Ia Evidence obtained from meta-analysis of randomised controlled trials.
Ib Evidence obtained from at least one randomised controlled trial.
IIa Evidence obtained from at least one well-designed controlled study without randomisation.
IIb Evidence obtained from at least one other type of well-designed quasi-experimental study.
III Evidence obtained from well-designed non-experimental descriptive studies, such as comparative studies, correlation studies and case studies.
IV Evidence obtained from expert committee reports or opinions and/or clinical experience of respected authorities.
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