In this article, we look at the causes and symptoms of vulvar varicosities, as well as treatment options if they do not resolve with time.
What are vulvar varicosities?
Vulvar varicosities may result in pain in and around the genital area.
Like every other area of the body, the vulva is home to a wide range of small and large blood vessels. During pregnancy, increased blood flow and pressure on the genitals and lower body can cause varicose veins.
Varicose veins are more common in the legs and feet, but some women also develop them in the vulva. The veins may be tiny and only moderately swollen or can be large, twisted, and painful.
Not all women with vulvar varicosities notice them or have symptoms. Even when symptoms do appear, a woman might not be able to see the veins. Anyone who suspects they have vulvar varicosities should speak with a doctor about the symptoms to ensure a proper diagnosis.
In addition to visible twisted or swollen veins, another main symptom of vulvar varicosities is a pain in or around the genitals.
The area may feel tender and sore, like a bruise. Some other symptoms include:
- a feeling of pressure or fullness in the genitals
- swelling in or around the genitals
- pain that gets worse after standing, sexual activity, or physical activity
The veins can also affect the perineum, the area between the vagina and anus. Some women with vulvar varicosities also develop hemorrhoids.
Pregnancy is the most common cause of vulvar varicosities. A 2017 study estimates that 18–22 percent of all pregnant women and 22–34 percent of women who have varicose veins near their pelvis develop vulvar varicosities.
An estimated 4 percent of women have had vulvar varicosities. They typically occur during pregnancy and usually go away on their own within 6 weeks after giving birth.
Vulvar varicosities are unusual in women who have not been pregnant. Although, sometimes, they occur in older women, particularly after standing for a prolonged period. Women who have varicose veins elsewhere on their body may also develop vulvar varicosities.
Every vein in a person's body has a valve that prevents blood from flowing backward. Veins in the lower body have to work very hard to carry blood back up to the heart.
During pregnancy, increased blood flow to the genitals and pressure on the lower body can make it more difficult for blood to flow in the proper direction. This may allow the blood to flow backward, creating varicose veins.
Also, during pregnancy a person's veins may dilate due to hormonal changes or pressure being placed on a major vein called the inferior vena cava, causing varicose veins.
Varicose veins tend to run in families, so women with close family members that have them may also develop them.
Rare causes include pelvic tumors that limit veins from draining.
When pregnant, sleeping on the left side may improve symptoms of vulvar varicosity.
Treatment usually focuses on managing symptoms at home, since vulvar varicosities typically go away within 1 month of giving birth.
Ways to prevent the veins from getting worse include:
- avoiding sitting or standing for long periods
- changing positions frequently
- avoiding wearing high heels or any shoes that are uncomfortable and put pressure on the lower body
- sleeping with the hips slightly elevated to prevent blood from pooling in the area
- drinking plenty of water
Techniques for reducing pain include:
- applying ice or heat to the area
- wearing supportive pregnancy underwear, such as compression and support stockings
- sleeping on the left side in pregnancy to place less pressure on the vena cava
- taking a non-steroidal anti-inflammatory drug (NSAID), such as Naproxen
Doctors do not recommend removing vulvar varicosities during pregnancy since they usually go away on their own. If the veins do not disappear a few months after giving birth, surgical procedures can be used.
The two most common procedures are:
- Vein embolization. This procedure uses a catheter to close damaged veins with a coil.
- Sclerotherapy. This procedure involves injecting a solution into the vein that blocks blood flow, eliminating the pain and swelling.
Both procedures can usually be carried out on an outpatient basis under general anesthetic, which means the person will be asleep and will not feel any pain.
Many women with vulvar varicosities have no symptoms other than swollen veins. A doctor will often be able to diagnose them with a simple visual examination.
Vulvar varicosities sometimes signal an underlying circulatory problem. A doctor may ask a person questions about their circulation, as well as if they have varicose veins elsewhere on the body.
Risks and complications
Poor circulation can cause blood to pool in the veins, leading to a dangerous blood clot called a deep vein thrombosis (DVT).
Blood clots in the deepest veins can break loose and travel elsewhere in the body. DVT is a life-threatening complication.
DVT is extremely rare with vulvar varicosities. However, a doctor will monitor the veins to ensure a blood clot does not develop. Signs of a blood clot include the vein becoming very painful, red, swollen, and hard. Women should immediately report these symptoms to a doctor.
Some women with vulvar varicosities might worry about how the veins will affect childbirth. However, these veins tend not to bleed very much and have no links to childbirth complications.
In some women, vulvar varicosities lead to a chronic pain condition called pelvic congestion syndrome. Damage to multiple veins in the vulva and genitals can cause numerous varicose veins, which may cause swelling and blocked blood flow to the area.
Home management with ice, heat, and NSAIDs may help, but some women may need surgery to treat the veins.
Are vulvar varicosities permanent?
Vulvar varicosities may become worse with each pregnancy.
Vulvar varicosities are not usually permanent. Symptoms typically disappear shortly after giving birth.
However, women who get them during one pregnancy may develop them with the next pregnancy. The veins may also get worse or more painful with each pregnancy.
When the veins do not disappear on their own, it is important to speak to a doctor about possible underlying causes, such as poor circulation.
Doctors can easily remove the veins with outpatient surgery. However, women with a history of varicose veins may continue to develop them, so it is often better to give them time to disappear without treatment.
Vulvar varicosities can look frightening, and some women may be embarrassed to discuss them with their doctor. However, these veins are widespread, and there is no reason to be alarmed.
Women should still speak to a doctor for a proper diagnosis and reassurance that the veins will likely disappear over time.