Vulvar Varicosities

Most of us are familiar with varicose veins. But what we don't often talk about are varicose veins that pop up on your lady bits during pregnancy aka vulvar varicosities. Anywhere from 4-24% of us experience vulvar varicosities during pregnancy and they can affect any part of the outside bits of your vagina (commonly the outer lips) and upper thighs.

Cause

Pregnancy causes blood to pool in your vulva due to

increased blood flow towards the pelvis
slower movement of blood from your legs back to your heart
hormones act on your blood vessel walls

If the increased pressure overwhelms your veins this will cause them to become stretched and enlarged, causing vulva varicosities.

Symptoms

Symptoms can vary, but you may experience

heaviness or a feeling of fullness around the vaginal area
swelling
pain or discomfort, often worsened by prolonged standing or sitting
feels lumpy to touch
visible veins (often blueish) that aren't normally as prominent

Diagnosis

Clinical examination
In cases where the diagnosis is unclear, an ultrasound may be necessary

Treatment

Treatment focuses on managing your symptoms during pregnancy, and we do this by reducing the pressure in your vulvar

Listen to your body - lie down and rest as needed
Change positions - avoid prolonged standing or sitting
Manage constipation - straining increases pressure on your veins
Avoid activities such as heavy lifting, pushing and pulling
Modify your exercise activities – swimming and Pilates can be great ways to keep active
Apply gentle pressure with your hand to your vulva when coughing, sneezing, or laughing
Do pelvic floor exercises
Apply ice packs to your vulva (15-20 minutes, every two hours)
Wear support garments that provide compression to your vulvar, such as firm-fitting underwear with a pad or SRC pregnancy shorts and leggings

Wear compression socks to improve lower limb circulation

Do not wear compression socks over the top of leggings that already provide compression ( e.g. SRC), as it can cause excessive compression
Shorts and compression socks (that don’t overlap) can be worn at the same time

Prognosis

If a vaginal birth is in your birth plan, then the good news is that as labor progresses the pressure in your veins is reduced and vulvar varicosities typically do not affect your ability to have a vaginal birth. If they do bleed, they only have minimal blood and are usually easily managed.

Symptoms usually fully resolve within 6-8 weeks after giving birth.

Top Tips

Schedule an appointment with your healthcare provider (GP, midwife, pelvic health Physio) for an accurate diagnosis
Don't wait for your symptoms to worsen. Act now to make changes.
Invest in medical-grade compression garments (with vulvar support) +/- compression stockings
Be kind to yourself! Dealing with vaginal varicosities is tough, so now is the time to prioritize your health.

References

Gavrilov, S. G. (2017). Vulvar varicosities: diagnosis, treatment, and prevention. International Journal of Women's Health, 9, 463–475. https://doi.org/10.2147/IJWH.S126165

Giannella, L., Montanari, M., Delli Carpini, G., Di Giuseppe, J., & Ciavattini, A. (2022). Huge vulvar varicosities in pregnancy: case report and systematic review. Journal of International Medical Research, 50(5), 3000605221097764–3000605221097764. https://doi.org/10.1177/03000605221097764
Kim, Anna S. MD^*; Greyling, Laura A. MD^†; Davis, Loretta S. MD^†. Vulvar Varicosities: A Review. Dermatologic Surgery 43(3):p 351-356, March 2017. | DOI: 10.1097/DSS.0000000000001008