Introduction to Vulvar Varicosities

Vulvar varicosities is a term used to describe varicose veins of the vulva. The vulva refers to all the structures that make up the external genitalia of those assigned female at birth.¹ The structures of the vulva are the:¹

• Mons pubis (pubic mound) is the fatty tissue that covers the pubic bones.
• Labia majora (outer lips) are the folds of skin around your vaginal opening.
• Labia minora (inner lips) are the folds of skin inside your labia majora.
• Clitoris is the highly sensitive tissue at the top of your vulva; it is a sensory organ that becomes erect during sexual arousal. 
• Vestibular bulbs are two masses of erectile tissue found on either side of the vaginal opening.
• Vulva vestibule is the smooth surface between the labia minora.
• Bartholin’s glands are two pea-sized structures behind the vaginal opening that secrete a mucus-like substance into the vagina.
• Skene’s glands are located on either side of the urethra, they secrete an antimicrobial substance into the opening of the urethra.
• Urethra is a tube from the bladder to the outside of the body which allows the excretion of urine. It is located behind the clitoris but in front of the vaginal opening.
• Vaginal is a tube connected to your cervix which is another tube connected to your womb. The vagina functions during sexual intercourse, childbirth, and menstruation.

Your veins are responsible for returning blood from your body to your heart. Varicose veins form when the process by which blood is returned to the heart does not happen efficiently. In the veins affected, blood collects, causing the veins to swell and twist.² Vulvar varicosities occur when the blood cannot flow properly through the veins in the pelvic region.³  

What are the Causes and Risk Factors of Vulvar Varicosities?

Vulvar varicosities are caused by blood that cannot flow normally through the veins of the pelvis and external genitals. When there is an increase in the pressure on the veins of the external genitals, there is an increased risk of vulvar varicosities.

Pregnancy is one such scenario, where the veins in your external genitalia have to work harder due to increased blood volume and the larger uterus. The appearance of vulvar varicosities during pregnancy is relatively common. It is estimated that between 18-22% of pregnant people will develop vulvar varicosities. However, in only 4-8% of people, will these varicosities persist and enlarge in the postpartum period.⁴ When you are pregnant, your womb increases in size to accommodate the growing foetus. A larger womb can compress the surrounding veins which means that the blood cannot flow through them properly. The veins swell and twist in response to the pooled blood and become varicose veins. The hormonal changes that occur during pregnancy also increase the likelihood that varicose veins form.³  

If you have varicose veins in the pelvis, you are also at an increased risk of developing varicose veins in the vulva. A study showed that 22-34% of women with varicose veins of the pelvis went on to develop vulvar varicosities. Your pelvic veins and the veins of the external genitals are connected. When the blood flow in the pelvic veins is impeded, the blood flow in the veins of the external genitals can also be affected, causing the formation of vulvar varicosities.⁴

What are the Signs and Symptoms of Vulvar Varicosities?

Vulvar varicosities can be asymptomatic (you may not feel any symptoms). However, they can cause your vulva to feel different from normal, as well as visible changes from its normal appearance.⁴

Visible changes you may experience are:⁴

• An increase in the size of the veins underneath the skin of the vulva, which look blue or purple.
• An alteration in the shape of your veins to a twisted, clustered configuration.
• Swollen veins on just your vulva, or also on yourupper thigh, and pelvis.
• Areas of your vulva, such as your labia, may also appear swollen or enlarged.

Non-visible changes include:⁴

• Pain in the vulva.
• A feeling of heaviness in your vulva.
• A burning sensation in your vulva.
• Pelvic pain.
• Pain during or after sex.
• Changes to your menstrual cycle.
• Frequent or painful urination.
• Discomfort in the lower abdomen.
• Itchiness in the skin of the vulva.

These visible and non-visible changes to your vulva may cause you to feel embarrassed. However, you shouldn’t feel any shame around seeking advice or treatment for a medical condition that is causing you any worry, pain, or discomfort.

How are Vulvar Varicosities Diagnosed?

Like many conditions that affect external genitalia, vulvar varicosities can remain undiagnosed due to feelings of fear, shame, or embarrassment surrounding seeing a healthcare professional. It is important to remember that there is no shame in seeking help for a medical condition. If you are worried, you can ask to be accompanied by a friend, family member, or a trained chaperone during your appointment. You will have a full physical exam and your medical history checked in your appointment. An external ultrasound maythen be performed to look at the veins in your external genitalia and pelvis. The ultrasound will show how the blood is flowing through your veins and identify points where this flow is congested.⁴

How are Vulvar Varicosities Treated?

The treatment for your vulvar varicosities will depend on your individual case – which veins are affected, what symptoms you are experiencing, and whether or not you are pregnant.

If you are pregnant, your vulvar varicosities will often resolve after the birth. In the meantime, it is often recommended that you:⁵

• Avoid standing for long periods.
• Avoid sitting with your legs crossed.
• Wear supportive clothing for your pelvic area that is pregnancy-friendly.
• Try lying with your hips elevated to ease symptoms.

If you are not pregnant, your vulvar varicosities have not resolved 3 months after giving birth, there is a high chance of complications associated with your vulvar varicosities, or you have signs of blood clotting in your veins (Deep Vein Thrombosis (DVT)) then one of the following medical interventions will be offered:⁴

• Sclerotherapy: This involves an injection of a foam or liquid solution into the problem veins. The solution causes the veins to scar and then slowly disappear.
• Ligation: this is a surgical procedure where small cuts are made in the affected area, allowing surgeons to remove parts of the problem veins.

Summary

The appearance of vulvar varicosities is common in people assigned female at birth who are pregnant or have varicose pelvic region veins. Vulvar varicosities can be asymptomatic but are often associated with both visible changes to the vulva, such as enlarged blue-purple veins, twisted or clustered veins, and swelling of the labia, and non-visible changes, such as pain, itching, and burning sensations. 

Vulvar varicosities are nothing to be embarrassed about, and you should speak to your healthcare provider so they can investigate the severity of them as you may need medical intervention. If the pain in the vulvar varicosities suddenly increases, you should contact your healthcare provider immediately as it may be a sign of deep vein thrombosis, which is a serious health condition.