During pregnancy, those assigned female at birth (AFAB) usually do not openly discuss their problems with vulvar varicosities or vulvar varicose veins, but it is important to do so. It is estimated that 4% of assigned females at birth will experience these conditions. Although vulvar varicose veins are rare in non-pregnant assigned females at birth, the real number is likely higher since many assigned females at birth either do not show symptoms or feel uncomfortable discussing them.¹

Introduction

What are vulvar varicosities?

Vulvar varicosities are also known as varicose veins of the vulva. Like other parts of the body, the vulva contains both large and small blood vessels. The condition commonly affects the feet and legs. However, some AFABs get the disease in their genital area. This happens when veins dilate within the labia minora and labia majora.²

How common is it?

Studies reveal that about 22% to 34% of AFABs experience vulvar varicosities. About 18% to 22% of pregnant AFABs are likely to experience similar conditions.²

What are the causes and risk factors?

Vulvar varicosities are associated with the following several risk factors:

Pregnancy is a high-risk factor that causes vulvar varicosities³

Pregnant AFAB are likely to experience some undesirable conditions, including varicose veins. During pregnancy, the lower body, including the genitalia, receives high blood flow. The higher pressures and increased blood flow may damage the valves in the veins, making them defective. Since these valves in the veins cannot close properly, there could be backward blood flow. The outcome is blood accumulation within the veins, causing varicose veins.

Varicose disease

Reflux of blood to the vessels is associated with varicose veins of the lower extremities.³ 

Family history

Genetics plays a role in the susceptibility to varicosities. If there is a direct family history, such as a grandmother or mother who suffered from varicosities, there may be a risk of developing the same condition.²

Prolonged standing period

The blood will not flow well when standing for an extended period compared to moving. Blood pooling within the veins creates weakness and pressure in the veins without movement to increase blood flow.²

Age

Females during the childbearing age of 25 to 45 years are more susceptible to developing vulvar varicosities. However, older AFAB may also experience vulvar varicosities.²

What are the symptoms of vulvar varicosities?

AFAB who have vulvar varicosities don’t necessarily experience symptoms. Others, however, will have bulging veins visible around the vulva or inner thigh. Additionally, some AFAB might experience pain, while others are asymptomatic.⁴,⁵

Here are a few symptoms you can look out for:

• Pain around the upper thighs or lower back is usually described as a dull ache
• Discomfort that gets worse from intercourse (dyspareunia) or from standing too long
• An increase in urination
• Bulging veins that appear bluish or purplish underneath the skin
• Veins that only appear on the vulva or along with other veins on the upper thighs, buttocks, or calves
• Fullness, pressure, itchiness, or discomfort in the vulva

What are the prevention strategies?

Fortunately, there are several prevention strategies, that ease discomfort and decrease the risk of developing vulvar varicosities.⁴,⁵ These strategies include:

Lifestyle changes

Regular exercise

Regular physical activity, such as walking or swimming, can improve blood circulation and prevent blood from pooling in the veins of the vulva. Therapeutic exercises designed to improve venous outflow from the legs and small pelvis organs can also reduce venous congestion.

A healthy diet to maintain weight 

Excess weight can increase pressure on the pelvic area, worsening vulvar varicosities. Maintain a healthy weight through balanced nutrition to reduce strain on the veins. Take plenty of water daily to ensure adequate hydration.

Supportive clothing

Wearing supportive undergarments, such as compression stockings or support briefs, can provide gentle compression to the pelvic area, helping to relieve the discomfort related to vulvar varicosities.

Elevating the legs

Elevating the legs can improve blood circulation, especially after extended periods of sitting or standing, and reduce swelling in the genital area. Consider elevating the legs above the heart for optimal relief.

Using cold compresses

Applying cold compresses to the vulvar area can help reduce swelling and discomfort associated with vulvar varicosities. Wrap a cold pack in a towel and apply it to the affected area for short intervals to avoid skin irritation.

Practising good posture

Maintaining good posture, especially when sitting or standing for extended periods, can reduce pressure on the pelvic area and alleviate symptoms of vulvar varicosities. Avoid crossing your legs while sitting, and try to distribute your weight evenly.

Avoiding prolonged sitting or standing

If your daily routine involves prolonged sitting or standing, take frequent breaks to move around and change positions. This can help prevent blood from pooling in the veins of the vulvar area and reduce discomfort.

Medical interventions

Venoactive drugs (phlebotonics) 

These drugs are indicated if there are symptoms of damaged vessels or varicose veins in the pelvis or lower extremities before pregnancy.² They work by strengthening the walls of veins and improving blood flow.

Sclerotherapy

This is an injection of a solution known as a sclerosant into the damaged vein. The solution causes the veins to scar and then slowly disappear.⁶

Ligation (Klarity Health Library)

It is a procedure where small incisions are made in the damaged area, allowing surgeons to remove parts of the bulged veins.⁶

Surgical options

Surgical procedures for varicosities and pelvic varicose veins are based on the clinical presentation and results of the examination.³ These procedures will help patients with isolated dilation of the pelvic venous plexuses if conservative treatment has failed and who have progressed with pelvic venous congestion symptoms and vulvar varicosities.

Seeking medical advice

If you experience persistent or severe symptoms of vulvar varicosities, consult with your healthcare provider. They have the expertise to provide personalised advice and support to help you effectively manage your condition.

Discovering effective strategies to manage and prevent vulvar varicosities can significantly improve your comfort and quality of life. Keep reading to learn more about this common condition and how you can take proactive steps to address it.

Summary

Vulvar varicosities, though common and often uncomfortable, can be managed and prevented with the right strategies. By maintaining a healthy lifestyle, practising good posture, and seeking medical advice when needed, individuals can ease symptoms and improve their overall well-being. Remember to prioritize self-care and consult with healthcare professionals for personalized guidance.

FAQs

• Are vulvar varicose veins harmful?

Any unusual changes in your body can be concerning, especially during pregnancy. Fortunately, there is almost no risk of complications or damage resulting from these varicosities, even though there is a slight chance of bleeding during childbirth.

• Is it common for women to develop vulvar varicosities without pregnancy? 

No, vulvar or vaginal veins rarely develop in those assigned females at birth unless they are pregnant.

• Can vulvar varicosities cause complications during pregnancy?

While vulvar varicosities typically do not pose serious risks, they can cause discomfort and may worsen throughout pregnancy. In rare cases, they may lead to complications such as excessive bleeding or blood clots, requiring medical attention.

• Is it possible to stop vulvar varicosities from happening?

While some risk factors for vulvar varicosities, such as pregnancy, cannot be avoided, certain preventive measures can help reduce the likelihood of developing this condition. These include maintaining a healthy weight, staying active, and practising good posture.

• When should I see a doctor about vulvar varicosities?

If you experience persistent or severe symptoms of vulvar varicosities, such as intense pain or swelling, it's essential to consult with your healthcare provider. They can assess your condition, provide appropriate treatment options, and address any concerns you may have.

• Is it safe to exercise during pregnancy?

It's generally safe to exercise during pregnancy, but it's important to consult with your healthcare provider for safe and suitable exercise options during pregnancy or if you have any medical concerns.