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If only today's men wore skirts...

Men get varicose veins, too. They just choose to ignore them - at their peril, says Cherrill Hicks
Since adolescence, Tim Ibbottson had had a mass of unsightly varicose veins on his left calf, but he did not have them "done" until he was approaching 40. "Then it was only on my doctor's advice," he says. "I wasn't worried about their appearance - beaches aren't part of my lifestyle. I did feel a bit self-conscious in the pool but men tend not to worry about that sort of thing. It's like having a paunch or going bald."

Men may not get pregnant, but they still suffer from varicose veins, according to Mr John Scurr, consultant vascular surgeon at the Middlesex Hospital. Male neglect of their veins, he says, is a mistake.

"Women tend to come for treatment in their twenties and thirties - for cosmetic reasons," he says. "Men don't have to wear a skirt so they ignore their veins until it is too late and they have developed problems such as ulceration."

Fortunately, this picture is changing, especially among professional men. The advent of executive medical screening programmes means many are getting their veins sorted out earlier rather than later, while Mr Scurr says that 25 per cent of his patients are men. "Varicose veins are still, however, something they don't want to talk about."

Varicose veins, which afflict about 15 per cent of adults, tend to run in families. While women usually develop them when they are pregnant - thanks to hormonal changes, combined with the extra weight - men often acquire them because of lifestyle: standing around a lot, either in bars or at work, makes some vulnerable. "For policemen, it's an occupational hazard," says Mr Scurr. Swelling develops, usually on the backs of calves and the insides of legs, when the valves that normally prevent blood from draining back down the legs become defective, causing blood to pool. The result is not only tortuous, swollen veins, but sometimes itchiness, aching legs, swelling of feet and ankles, dry, scaly skin - caused by lack of oxygen - and, in severe cases, leg ulcers.

Traditionally, treatment involves either surgery for more severe cases, in which the vein is "stripped" from the leg, or injections of an irritant solution which, combined with tight bandaging, causes the blood to be diverted to healthier veins.

Depressingly, varicose veins tend to recur after treatment, but Mr Scurr says that nowadays, with proper assessment, this should not happen. At the Middlesex and other large specialist units, doctors now use ultrasound to scan veins below the skin surface and assess which parts of the venous system are incompetent. "Ultrasound means we can remove hidden varicosities as well as surface veins," he adds. New surgical techniques mean that only the smallest of incisions are needed; this results in fewer stitches and less scarring.

Smaller veins can be treated by laser or high-intensity light (known as photoderm), which "cook" the vein and are less invasive than injections, although these treatments are not yet widely available on the NHS.

Can varicose veins be prevented? Probably not, if they are hereditary, but men who tend toward them, or who spend much of their lives standing, should, Mr Scurr advises, wear elastic support socks which come up to the knee and which can be bought from chemists. Plenty of walking may also help.