Vulvar Varicosities

What are vulvar varicosities?

Vulvar varicosities are varicose veins that appear on your vulva. They usually show up during pregnancy, when the changes in your body that support a growing fetus cause your veins to become stressed and swollen. These veins can look unsightly and feel uncomfortable. But they usually go away without treatment about six weeks after your baby is born.

Who do vulvar varicosities affect?

Vulvar varicosities usually appear during pregnancy, especially around the third or fourth month. In rare cases, people who aren’t pregnant get them, too. If you have a condition called pelvic congestion syndrome (PCS), the chances are greater that you’ll have vulvar varicosities.

How common are vulvar varicosities?

About 4% of people with vulvas have vulvar varicosities. That number goes up to 20% for pregnant people. Around 20% to 35% of people who have varicose veins in their pelvis have them on their vulva, too. It’s hard to know just how common these veins are, though, because vulvar varicosities don’t always cause symptoms. You can have them without knowing they’re there.

What are the symptoms of vulvar varicosities?

You may not notice any symptoms with vulvar varicosities. Or, you may notice that your vulva looks and feels different than it has in the past.

You may see:

• Bulging veins that appear bluish or purplish underneath your skin.
• Veins that look twisted, swollen or bunched into a cluster.
• Veins that only appear on your vulva or that appear along with other veins on your upper thighs, butt, or calves.

You may feel:

• Raised areas of skin with swollen veins underneath.
• Fullness, pressure, pain, itchiness or discomfort in your vulva.
• Pain or discomfort in your upper thighs and lower back.
• Pain or discomfort that gets worse from intercourse (dyspareunia) or from standing too long.

What causes vulvar varicosities?

Vulvar varicosities appear when the veins in your vulva struggle to circulate blood. These veins move blood from your low 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 and swell in your veins.

Your body goes through changes during pregnancy that increases your chances of getting vulvar varicosities.

• 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 do more work 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 more stretchy and less able to contain the blood flowing inside them. Your veins can get bigger and twisted as a result.

Less is known 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.

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?

Treatment depends on whether or not you’re pregnant and if the varicose veins in your vulva are associated with swollen veins in other parts of your body, too. If you’re pregnant, chances are that your vulvar varicosities will go away eventually without treatment. If you’re not pregnant or if it’s been more than three months since you delivered the baby and the veins are still there, your provider can recommend treatments:

• 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.
• Ligation. Your provider can make tiny cuts in your skin so that they can access the veins and remove small segments of them.

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?

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 8 cups a day.
• Sleep with your hips elevated, higher than your belly, to improve your circulation.
• Lie down with your hips elevated or on your left side so that you're taking pressure off the veins in your vulva.
• Wear a support garment for your pelvic area. Choose one that’s designed to support vulvar varicosities.

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 a healthy diet.
• Wear comfortable shoes.
• Don’t spend too much of your day seated.
• Wear clothing that isn’t too tight in your groin area.

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 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 is 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.

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.

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.

Can vulvar varicosities be treated?

Yes, but treatment will depend on your unique situation. If you’re pregnant, your veins will likely go away after your baby’s born, so your best treatment approach may be managing symptoms. 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 or not other veins in your pelvis and in your legs may be affected, too.

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 unsightly veins only adds insult to injury. Take comfort in knowing that these changes are likely short-term. And if they’re still around after your baby comes, your healthcare provider can recommend treatments that can bring you relief.