Vulvar Varicosities

What are vulvar varicosities?

Vulvar varicosities are varicose veins that appear on your vulva (external female genitals). They usually show up during pregnancy, when your blood volume increases significantly to support a growing fetus. These changes in blood flow during pregnancy can cause the veins in your genital region to become swollen.

Vulvar varicosities typically appear in the third or fourth month of pregnancy. Vulvar varicosities can be uncomfortable, but they shouldn’t affect your labor or delivery. They usually go away without treatment about six weeks after your baby is born.

In rare cases, people who aren’t pregnant get them, too. This is more likely if you have varicose veins in other places on your body (like your pelvic or groin area).

How common are vulvar varicosities?

About 4% of people with vulvas have vulvar varicosities. That number goes up to 20% for pregnant people. It’s rare to have a severe case of vulvar varicosities, even during pregnancy.

What are the symptoms of vulvar varicosities?

You may not notice any symptoms with vulvar varicosities. Or you may notice that your vulva feels swollen and uncomfortable. Some other symptoms are:

• Fullness, pressure, pain and itchiness in your vulvar region.
• Pain or discomfort that gets worse during sex (dyspareunia) or from standing or sitting too long.

Vulva varicosities can appear alone or along with varicose veins in your legs, calves or upper thighs.

What do vulvar varicosities look like?

You may notice bluish or purplish veins that pop out beneath your skin. Other than bulging veins, your veins may also appear twisted, swollen or bunched into a cluster.

Can vulvar varicosities be itchy?

Possibly. Skin irritation and itchiness can be a symptom of vulvar varicosities.

Can vulvar varicose veins burst?

Yes, they can. Rarely, the veins can burst (or rupture) during a vaginal delivery. The bleeding is usually mild, and your provider can control it without it causing problems.

Do vulvar varicosities hurt?

Not all of them hurt, but some do. Vulvar varicosities don’t feel the same way for every person. Your veins may feel mildly uncomfortable, or the pain may be severe. Whether your veins feel painful or not, it’s a good idea to let your provider know about them.

What causes vulvar varicosities?

Vulvar varicosities appear when the veins in your vulva struggle to circulate blood. These veins move blood from your lower body and your pelvis up — against gravity — to your heart. When they’re able to keep the blood flow steady, you likely won’t even notice these veins doing this important work. When there’s more blood to move than these veins can handle, the blood starts to pool (or collect) and swell in your veins.

Your body goes through changes during pregnancy that increase your chances of getting vulvar varicosities, like:

• Increased blood flow to your pelvis. More blood flows to your pelvis when you’re pregnant. More blood volume means that your veins have to work harder to carry that extra blood to your heart. Sometimes, your veins swell because they can’t handle all the extra blood flow.
• Increased uterus size. Your uterus gets bigger during pregnancy to support a growing fetus. This new weight adds pressure to your pelvic area, including the veins in your vulva. The veins can become squeezed, which makes it harder for them to carry blood back to your heart.
• Hormone changes. Hormone levels change during pregnancy, and some of these changes can affect the lining of your veins. The lining can become stretchier and less able to contain the blood flowing inside it. Your veins can get bigger and twisted as a result.

Experts know less about what causes vulvar varicosities in people who aren’t pregnant. It’s likely that your genetics influence how well your veins manage blood flow.

Who is more likely to have vulvar varicosities?

Being pregnant is the biggest risk factor for vulvar varicosities. The increase in blood flow, hormones and the heaviness of your uterus make you more prone to them. Other things that increase your risk are:

• Family history of varicose veins.
• Having overweight (a body mass index, or BMI, greater than 25). This can put extra strain on your veins.
• Age. Your veins tend to be weaker and more prone to varicose veins as you get older.
• Having pelvic congestion syndrome (PCS).
• Standing or spending lots of time on your feet.

What are the complications of vulvar varicosities?

There aren’t any life-threatening or long-term complications of vulvar varicosities. Potential complications are:

• Pain and discomfort: This is the most common complication. Your pain can intensify with certain activities like sitting or standing. It could interfere with your quality of life. In some cases, the pressure in your veins can cause extreme skin irritation or ulceration.
• Blood clots: If you have risk factors like obesity or a history of blood clots, vulvar varicosities could cause a clot to form. Talk to your provider if you believe you’re at risk for blood clots.
• Pelvic congestion syndrome (PCS): This chronic condition happens when the veins in your vulva and genitals become so swollen that you lose blood flow to the area.

How are vulvar varicosities diagnosed?

Your healthcare provider will do a physical exam to see if you have vulvar varicosities. As part of the exam, your provider may take a closer look at your vulva while you’re lying down and while you’re standing. Viewing your vulva from both these angles can help your provider compare how your veins look without pressure (lying down) and with pressure (standing up).

Your provider may order an imaging procedure to check the size of your veins and to track how well your blood circulates through your veins. Imaging can also let your provider know if your varicose veins are only in your vulva or if you have varicose veins in other parts of your pelvis, too. Your provider can use this information to recommend treatment.

How are vulvar varicosities treated?

If you’re pregnant, vulvar varicosities will likely go away after your baby’s born, so your best treatment approach may be managing symptoms. If you still have them a few months after you give birth, your provider will recommend treatment.

If you’re not pregnant, your provider can work with you to determine what’s likely causing your swollen veins. The treatments they suggest will depend on what’s causing the swelling and whether other veins in your pelvis and legs are also affected.

Potential treatments for vulvar varicosities are:

• Sclerotheraphy: This is the most common type of treatment for vulvar varicosities. Your provider injects a liquid or foam solution into your veins that causes them to scar, close and eventually disappear.
• Phlebectomy: Your provider makes small incisions in your skin to remove the affected veins.
• Ligation: Your provider can make tiny cuts in your skin so that they can access the veins and remove small segments of them.
• Transcatheter embolization: Your provider uses a catheter to inject materials into your blood vessels to block blood flow to the area.

Your provider can help you weigh the potential benefits associated with these procedures against more conservative treatments, like managing symptoms.

How can I manage symptoms of vulvar varicosities?

Vulvar varicosities usually go away six weeks after you’ve had your baby. In the meantime, keep the following in mind as you manage your symptoms:

Don’t:

• Sit, squat or stand for too long. These positions make it easier for blood to pool in your veins.
• Eat lots of salty foods. Salt causes you to store more fluid in your body, and this only stresses your veins.

Do:

• Drink lots of water to help improve your blood flow, at least 10-12 cups a day.
• Lie down with your hips elevated or on your left side so that you’re taking pressure off the veins in your vulva.
• Apply cold compresses to your vulva.
• Wear a support garment for your pelvic area. Choose one that’s designed to support vulvar varicosities.

What do I wear for vulvar varicosities?

There are support garments exclusively for people with vulvar varicosities, similar to compression socks for your legs. They work by compressing your veins, which can help with swelling and discomfort.

Is walking good for vulvar varicosities?

Walking helps get the blood circulating throughout your body. Just take care not to overexert yourself. Too much activity can make your veins feel more painful.

How can I prevent vulvar varicosities?

You can’t prevent vulvar varicosities. But you can do things to improve your circulation overall so that blood flows better throughout your entire body:

• Exercise regularly.
• Eat healthy and nutritious foods as often as possible.
• Stay within the recommended pregnancy weight gain range.
• Wear comfortable shoes, especially if you’re standing for long periods of time. Avoid wearing high heels.
• Don’t spend too much of your day seated.
• Avoid wearing clothing that’s super tight around your groin.
• Elevate your feet when possible and wear compression socks during the daytime or when on your feet for long periods of time.

What can I expect if I have vulvar varicosities?

If you’re pregnant, you can expect the veins in your vulva to go back to normal about six weeks after you deliver your baby. The symptoms can be frustrating, but vulvar varicosities don’t cause pregnancy complications. You should be able to deliver your baby vaginally, with no risks to your baby.

If you’re not pregnant, work with your provider to monitor your veins and discuss treatment options.

When should I worry about vulvar varicosity?

Try not to worry about vulvar varicosities. They often disappear entirely a few weeks after you deliver your baby. If you have severe symptoms or they don’t go away after delivery, your healthcare provider can recommend treatment. Always let your healthcare provider know about your symptoms so they can monitor you and watch for any complications.

When should I see my healthcare provider?

Let your provider know about any issues you’re having with your circulation, including vulvar varicosities. Also, your provider can help you manage symptoms and offer treatment options.

Deep vein thrombosis (DVT) is a serious blood clot that’s rare among people with vulvar varicosities. Still, it’s a good idea to know what the symptoms are, just in case. See your provider right away if you notice that your veins have become:

• Especially painful.
• Red.
• Swollen.
• Hard to the touch.

Are vulvar varicosities worse during periods?

It’s very rare to get vulvar varicosities when you’re not pregnant. But the changes that occur during your menstrual cycle may worsen your symptoms.

A note from Cleveland Clinic

Noticing enlarged veins on your genitals can feel embarrassing. Feeling itchiness, fullness or pain in your vulva at the very moment that you’re noticing these veins may add insult to injury. Take comfort in knowing that the changes are likely short-term. Many at-home treatments may make it easier to manage your symptoms. And if they’re still around after your baby comes, your healthcare provider can recommend additional treatments that can bring you relief.