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Vaginal venous plexus

The vaginal venous plexus is an extensive interconnected venous network that surrounds the vagina and communicates broadly with adjacent pelvic venous systems. It drains blood from the vaginal wall and contributes to the pelvic venous plexus.

This plexus communicates with the uterine venous plexus, vesical venous plexus, rectal venous plexus, and internal pudendal veins, forming part of the complex pelvic venous circulation. The venous blood ultimately drains into the internal iliac veins via the uterine and internal pudendal veins.

Clinically, the vaginal venous plexus is significant in pelvic congestion syndrome, varicosities, postpartum hemorrhage, vaginal trauma, and gynecologic surgeries. Due to its rich anastomotic connections, it may serve as a collateral pathway in pelvic venous obstruction but can also be a source of severe bleeding when injured.

Synonyms

  • Plexus venosus vaginalis

  • Vaginal venous network

Function

  • Drains venous blood from the vaginal walls

  • Communicates with uterine, vesical, rectal, and pudendal venous plexuses

  • Provides collateral pathways in pelvic venous return

  • Plays a role in female sexual physiology through vascular engorgement during arousal

  • Clinically important in pelvic varices, venous thrombosis, and surgical bleeding control

MRI Appearance

T1-weighted images:

  • Veins appear as hypointense tubular or serpiginous structures around the vagina

  • Surrounded by intermediate signal pelvic soft tissue

T2-weighted images:

  • Normal flowing blood: signal void

  • Varices or slow flow: hyperintense, dilated tubular structures encasing the vagina

STIR:

  • Suppresses fat, increasing conspicuity of dilated veins

  • Thrombophlebitis or inflammation: perivenous edema appears bright

T1 Fat-Suppressed Post-Gadolinium:

  • Venous plexus enhances brightly and homogeneously

  • Dilated varices are easily delineated

  • Helpful in pelvic congestion syndrome and vascular malformations

MRV (Magnetic Resonance Venography):

  • Normal signal: flowing venous blood appears bright hyperintense with gadolinium contrast

  • Varices: appear as markedly dilated enhancing venous channels encircling vagina

  • Thrombosis: non-enhancing filling defects within enhancing plexus

  • Provides comprehensive mapping of pelvic venous plexus and communications

CT Appearance

Non-contrast CT:

  • Vaginal venous plexus usually poorly visualized

  • May appear as soft tissue densities adjacent to vaginal wall if markedly dilated

CT Post-Contrast:

  • Enhances as serpiginous vascular structures around the vagina

  • Detects varicosities, extrinsic compression, or pelvic masses displacing venous plexus

CTV (CT Venography):

  • Normal signal: enhancing venous plexus appears as bright hyperdense network

  • Varices: dilated tortuous veins with homogeneous enhancement

  • Thrombosis: intraluminal filling defects within enhancing venous plexus

  • Provides 3D reconstructions for mapping pelvic venous drainage, varices, and pre-surgical evaluation

MRI image

Vaginal venous plexus MRI axial anatomy image-img-00000-00000

CT image

Vaginal venous plexus CT axial anatomy image-img-00000-00000