Vulvar Varicosities: A Comprehensive Review of Pathogenesis, Diagnosis, and Treatment
10.37923/phle.2025.23.1.12
- Author:
Su-kyung KWON
1
;
Sang Su LEE
;
Hyangkyoung KIM
Author Information
1. Department of Surgery, Seoul Medical Center, Seoul, Korea
- Publication Type:Review Article
- From:
Annals of phlebology
2025;23(1):12-18
- CountryRepublic of Korea
- Language:English
-
Abstract:
Varicosities of the vulva are a frequent but often underrecognized sign of venous disease and are rarely written about. However, they may reflect complex pathophysiologic mechanisms, including pregnancy-related hormonal and hemodynamic changes, intricate pelvic venous anatomy, and altered intra-abdominal pressure dynamics. This narrative review summarizes current evidence on the epidemiology, anatomical pathways, etiologic factors, diagnostic modalities, and therapeutic strategies relevant to vulvar varicosities. Accurate identification of the underlying venous pathology—whether due to reflux, anatomic variation, or pelvic outflow obstruction—is essential to guide appropriate treatment selection. Duplex ultrasonography and cross-sectional imaging play a pivotal role in this diagnostic process, while selective venography should be reserved for carefully selected cases in which noninvasive imaging is inconclusive or intervention is being planned. Management strategies range from conservative observation, particularly during pregnancy, to targeted interventions such as sclerotherapy, surgical excision, and endovascular embolization. The presence of pelvic congestion syndrome must be recognized and addressed to ensure durable symptom control and prevent recurrence. Clinical decision-making benefits from a multidisciplinary framework involving vascular surgery, interventional radiology, and gynecology. By providing a comprehensive overview of this often-overlooked condition, the present review aims to promote earlier recognition, improve diagnostic precision, and support individualized treatment planning in women affected by vulvar varicosities.
