Atypical manifestations of vulvar varicose veins during pregnancy: A case report

During pregnancy, the rate of vulvar varicose veins (VVVs) is 4 to 22%. It is commonly believed that VVVs is mostly asymptomatic during pregnancy in the prevailing majority of cases, that’s why little attention is paid to the symptomatic forms, especially in cases where VVVs mimic the soft tissue formation or are accompanied by inflammatory events. The article presents two clinical cases of atypical manifestations of VVVs in pregnant women. The key complaints included itching, burning sensation and swelling in the vulva, changes in the volume of vaginal discharge, which were initially considered as manifestations of vulvovaginal candidiasis (VVC) and combined with bacterial vaginosis. However, the symptoms were not relieved after local and systemic therapy with natamycin in the first case and repeated courses of local therapy with neomycin combined with ternidazole and nystatin accompanied by the systemic use of metronidazole in the second case. The examination findings showed VVVs in both pregnant women. The use of phlebotropic therapy with diosmin 600 mg resulted in a reduction in itching severity, a decrease in swelling, and disappearance of burning sensation. No negative effects of diosmin on the course of pregnancy and childbirth, or the well-being of newborns were observed. Both cases clearly demonstrate the impact of atypical VVV symptoms on the overdiagnosis of infectious and inflammatory diseases of the vulva, and inadequate choice of pharmacological therapy associated with that, ultimately leading to the persistence of complaints, decreased quality of life in pregnant woman and increased risk of side and adverse effects during treatment. It seems appropriate to consider the probability of contribution of VVVs when pregnant women complain about itching, burning sensation and swelling of the vulva, especially in the absence of positive laboratory results of vaginal candidiasis and/or bacterial vaginosis and in the presence of persistently recurring symptoms on antifungal, antibacterial and antiinflammatory therapy. The use of diosmin as a trial therapy appears promising if there is a high probability that such symptoms originate from venous diseases.