How to Identify and Treat Vulvar Varicosities

It’s possible to have VVs and not even know it. It can be difficult to see the vulva and identify changes to it, especially during pregnancy.

VVs occur on the labia major and minor, the lips and skin folds of the vulva. Some visual symptoms of VVs include:

• veins that appear twisted and that bulge out from your skin
• veins that are soft and blue or purple in color

Some women experience more than just visible changes to the vulva. VVs can also cause:

• pressure or pain in your vulva
• heaviness or a full feeling in your vulva
• discomfort while walking
• pain during sex
• itchiness

VVs can be an isolated condition. However, you may also experience varicose veins on your legs or elsewhere in your pelvic region.

Women who are pregnant may find that VVs appear during the middle of pregnancy.

Varicose veins in the legs develop when parts of the vein weaken. When this happens, it makes the body less able to efficiently circulate blood from your lower extremities back to your heart. Blood in your legs then pools, resulting in bulging, squiggly, protruding, and sometimes painful veins.

Aging is often a factor in developing varicose veins. Over time, the veins become less efficient in structure and function, causing venous blood circulation to slow. You may also be more susceptible to this condition if you have a family history of varicose veins or if you’re overweight.

That said, you’re most likely to experience VVs during pregnancy. During this time, your body produces more blood, which flows more slowly from your legs back up to your pelvis. The changing levels of estrogen and progesterone hormones in your body also cause the walls of your veins to relax.

Having pelvic varicose veins also increases your chances of developing VVs. This condition can lead to pain in your pelvis and surrounding areas, like the lower back and upper thighs.

According to a 2017 study, it’s estimated that 18 to 22 percent of women who are pregnant and 22 to 34 percent of women with pelvic varicose veins have VVs. These numbers may even be higher. Many women never receive a diagnosis of VVs because they can’t see or feel the varicose veins in their vulva. Others choose not to seek medical help.

Your doctor may be able to diagnose VVs after performing a physical examination. In addition to asking about your symptoms, your doctor may ask you to stand so that they can examine any associated swelling.

In some cases, an ultrasound may be necessary to diagnose VVs. This imaging test can help your doctor identify varicose veins and evaluate their severity. It can also help your doctor identify any clotting or blood flowing in the wrong direction.

Other tests are also available to determine the scope of the condition. For example, your doctor may suspect a larger venous condition, like pelvic congestion syndrome, linked to pelvic varicose veins.

If so, they may use one of the following tests to make a diagnosis:

• heart CT scan
• magnetic resonance angiography (MRA)
• selective venography

Your doctor will likely recommend home-based management methods as a first-line approach.

If your symptoms are more severe or associated with additional conditions, your doctor may also recommend that you:

• Use only a small amount of a gentle soap for bathing the vulvar region. Apply a topical corticosteroid cream after your bath to relieve itching.
• Take prescription medication of low molecular weight heparin if there’s a blood clot within the VV. This prevents further blood clots from forming and allows the body to be able to break down the VV blood clot. Women who have this condition while they’re pregnant can take a five-day course of this medication during the later trimesters of pregnancy.
• In rare circumstances, have an outpatient medical procedure called sclerotherapy. Your doctor will inject your varicose veins with a solution that causes them to scar and close. This will cause the veins to fade over time. If performed, it’s preferred to have done when not pregnant.

Women who have severe symptoms and aren’t pregnant may benefit from more aggressive treatment methods. This includes:

• Sclerotherapy.
• Echosclerosis. This is an expanded version of sclerotherapy with ultrasound guidance.
• Phlebectomy. This treatment removes the affected veins, requiring a few small incisions made on the skin’s surface.
• Transcatheter embolization. This treatment utilizes fluoroscopic imaging (a type of X-ray) to help your doctor guide a catheter into the varicose vein. Your doctor then places a coil or sclerotherapy solution to treat the vein.

Developing this condition while pregnant may have you concerned about childbirth. Although there’s a chance that your veins will bleed during vaginal delivery, this shouldn’t result in any significant risk for complications or prevent you from having a vaginal delivery.

If you have any questions or concerns about your options for delivery, talk with your doctor. They can walk you through your options and help put your mind at ease.

VVs can be unpleasant to experience. When pregnant, this condition can cause discomfort that requires treatment at home or by your doctor. VVs typically fade within a few months of childbirth. Developing the condition outside of pregnancy may require more extensive treatments, but there are several procedures that can help you alleviate your symptoms.

It may not be possible to prevent VVs, especially during pregnancy. But there are things you can do to reduce your overall risk of varicose veins.

You can help encourage proper circulation in your legs by:

• exercising
• eating healthy
• watching your weight
• keeping your legs elevated off the ground when sitting
• moving from sitting to standing often
• wearing flat footwear
• wearing compression stockings, such as Jobst or TED hose
• staying away from clothing that’s too tight at the waist or groin