Overview  

Vulvar varicosities, a subset of pelvic congestion syndrome, occur when pelvic veins do not function normally, resulting in varicose veins on the external female genital region – the vulva.¹ Varicose veins are engorged, twisted veins that can protrude from beneath the surface of your skin and may be painful to touch. Veins carry blood from your body to your heart and contain valves to prevent the blood from flowing backwards.² Varicose veins often have damaged or weakened walls and valves, often leading to retrograde blood flow;³ over time, continuous damage to the vein wall can lead to the hallmark appearance of varicose veins. When this damage occurs to veins of the lower extremities, including the pelvis, it can result in vulvar varicosity. One of the most common causes of vulva varicosity is pregnancy, which will be discussed further in this article.³ Vulvar varicosities are often the cause of chronic pelvic pain and can affect normal functions such as standing.¹ Generally, women are more likely to develop varicose veins than are men. The condition is relatively common and not always life-threatening; however, the emotional toll faced by those affected can be challenging. This article will guide you through some of the most common causes and symptoms of vulvar varicosities and discuss the role of pregnancy in its development, as well as provide resources for support. 

What causes vulvar varicosities?  

Vulvar varicosities have been estimated to occur in approximately 4% of women.⁴ Several factors can simultaneously cause and exacerbate varicose veins of the vulva. Damaged and/or weakened vein walls and valves are the primary cause of vulvar varicosities, but this may be influenced by factors including:^1,3 

• Family history: a family history of varicose veins can increase your chances of developing them.  
• Age: the ageing process can result in weakened veins that are more vulnerable to varicosity
• A history of blood clotting (thrombosis): blood clots may damage veinous valves, leading to vulvar varicosities
• A history of varicose veins: previously having varicose veins, particularly in the thigh, is associated with increased risks for vulvar varicosities
• Lifestyle, including:
  • Sedentarism: prolonged sitting has been associated with higher prevalences of varicose veins. 
  • Weight: increased weight can increase blood pressure, leading to damaged veins as they struggle to withstand this and increasing the susceptibility of varicose veins. 

Pregnancy and vulvar varicosities 

Pregnancy may cause or exacerbate vulvar varicosities.^1,3 Increased blood volume and particularly increased blood supply to the pelvic region can increase the chances of developing the condition; increased blood flow to the pelvis provides the developing baby with oxygen and nutrients and removes waste.^5,6 The resulting increased functional burden to the pelvic veins can increase the chances of developing vulva varicosities, particularly when a woman has had more than one pregnancy.^3,6 Weight gain in pregnancy can further increase the chances of developing vulvar vestibulitis. This can be a difficult challenge, as most pregnant women will inevitably gain weight. Pregnancy weight gain is normal; however, excessive weight gain could pose a health concern. It is crucial to nourish your body during pregnancy - both for you and your baby - but to do so healthily while managing weight, where possible. The NHS advises healthy eating, but without excess restriction, as dieting and immoderately low weight can also be harmful in pregnancy.  

What are the symptoms of vulvar varicosities? 

Women affected by this condition may experience its symptoms differently due to differences in pain perception.³ Be that as it may, coping with physical pain in such a sensitive area can be both emotionally and physically challenging. The most conspicuous symptom of vulvar varicosities is the presence of bulging, lumpy veins beneath the surface of your skin.³ The veins are often blue in appearance and painful. Although one might reasonably expect, bleeding of the varicose veins is not a common symptom of this condition, although painful menstruation can be;³ bleeding from vulvar varicosities is extremely rare, but some common symptoms include:^1,3,6  

• An overactive bladder  
• Chronic pelvic pain  
• Fatigue  
• Vulvodynia 
• Vulvar lip swelling  
• Fullness of the vulvar lips 
• Heaviness and/or pressure in the pelvic region  
• Lower abdominal pain 
• Burning sensations 
• Itching  
• Moisture-associated skin damage (maceration) 

Exacerbators of vulvar varicosities symptoms  

A common challenge of vulvar vestibulitis, beyond the typical symptoms, is the hindrance of normal activities, which can exacerbate the already-challenging symptoms. Activities where you may notice worsening of symptoms include:^3,6  

• During and after intercourse (Pain may persist for hours);
• Before or during menstruation;  
• While urinating; 
• Periods of prolonged standing and sitting; 
• Crossing legs while sitting;  
• Although rare, delivery in pregnancy may cause bleeding.

Finding support  

Vulvar vestibulitis can be isolating due to the intimate nature of the condition as well as feelings of insecurity towards its cosmetic presentation.³ This may cause feelings of embarrassment and act as a psychological barrier to further discourage women from seeking health support, particularly gynaecological consultations. Charities that may provide support for women affected by chronic pelvic pain include: 

• Pelvic Pain Support Network 
• International Pelvic Pain Society  

Summary 

Vulvar varicosities occur due to impaired functioning of the veins, leading to a bulky, coiled appearance in the vulva region. Common symptoms of the condition include chronic pelvic pain and pain during intercourse. The condition is not always life-threatening but may impair the confidence of those affected due to cosmetic concerns. Pregnant women are more likely to develop vulvar varicosities due to normal changes that occur during this process, including weight gain, and this is further increased if she has had more than one full-term pregnancy. Paucity, underdiagnosis, limited research, and women’s (understandable) hesitancy to seek medical attention for vulvar varicosities may contribute to the scarcity of information about this condition. It is nonetheless one that can largely impact the emotional and physical health of those affected and requires further research and understanding to improve health outcomes. 

FAQs 

When should I consult a doctor for vulvar varicosities? 

It is important to consult a healthcare professional if you suspect you may have this condition, especially if it is interfering with daily activities.  

Can vulva varicosities go away on their own?  

Yes, spontaneous regression is common, although so is recurrence. This also applies to post-treatment reoccurrence.  

Are there treatments for vulvar varicosities?

There are treatments available for varicosities, including surgery. It is important to thoroughly consult with doctors to fully comprehend the cost-benefit outcomes of any medical treatment.