Vulvar Varicose Veins: Symptoms and Treatments
Medically reviewed by Barbara Terpstra, MD, on May 20, 2024
We spoke with Dr. Barbara Terpstra, the lead physician of two Center for Vein Restoration vein clinics in Chicagoland’s suburbs, Orland Park, IL, and Downers Grove, IL, about a common but often ignored condition, particularly among pregnant women and those with pelvic congestion syndrome: vulvar varicose veins. Also known as vulvar varicosities, these enlarged and swollen veins in the vulva can cause itching, burning, and feelings of fullness or pressure in some women.
With her extensive clinical experience and as a renowned expert in venous health, Dr. Terpstra provides a comprehensive understanding of vulvar varicosities. Her insights, backed by her expertise, underscore the importance of proactive lifestyle adjustments and appropriate medical interventions for those affected by this condition.
What are vulvar varicose veins?
Dr. Terpstra: “Vulvar varicosities are quite simply varicose veins that form in the outer regions of the female vulva. The most common cause of these is pregnancy. We often see them in the second and third trimesters of pregnancy.
Another cause of vulvar varicosities is a condition we call pelvic congestion syndrome. On rare occasions, they can be caused by abnormal masses or pressure from above in the abdomen pressing down into the pelvis.
Varicose veins of the vulva are, we believe, present in about 4 percent of the entire female population. Add a pregnancy on top of that, and that number bumps it up to about 20 percent of women experience vulvar varicosities.”
What are the most common symptoms of vulvar varicose veins?
Dr. Terpstra: “The patient is the one who brings the symptoms to our attention. We don't routinely examine for vulvar varicosities because the patient will definitely tell us about the discomfort.”
Pain and visible veins are the most common symptoms first reported to the physician. Very rarely do vulvar varicosities get to the point where they cause bleeding. It's much more common for them to cause things like pelvic pressure, pain with sitting for long periods of time, pain with intercourse, and pain and throbbing with menstrual period.
Varicose veins that spread into the upper thighs or the buttocks often indicate a risk of vulvar varicose veins. Lower back pain with prolonged standing or pain with intercourse are also good indicators. I should say pain with penetrative intercourse is a good indicator of issues with pelvic congestion and vulvar varicosities.”
Are there risk factors that make some women more prone to developing this condition?
Dr. Terpstra: “If you see varicose veins in other parts of the body, like the legs or upper thighs, that can certainly put a woman at risk. It means that you are prone to develop varicose veins anyway. Add a pregnancy or two on top of that, or a job or a profession that keeps you standing for long periods of time with no break, no ability to sit down, or the exact opposite—a job that keeps you confined to a desk without any ability to get up and move around—puts one at higher risk.
Also, if you have a condition called pelvic congestion syndrome while you're pregnant, there’s 35 percent of those women will develop vulvar varicose veins. Add on a few pre-existing conditions like a family history of varicose veins, pre-existing varicose veins in the lower extremities (meaning in the legs but mainly in the thighs), and pelvic congestion syndrome, and your risk goes up much, much higher.”
What kind of diagnostic tests or examinations are used to evaluate vulvar varicosities?
Dr. Terpstra: “A competent physical exam is really all that's needed. You don't need an ultrasound, and you don't need any diagnostic or surgical testing.”
Are there any home remedies or self-care tips you'd recommend for relieving discomfort from vulvar varicosities?
Dr. Terpstra: “First of all, pay attention to your wardrobe. Any binding or tight garments can increase the discomfort. Exercising regularly and eating healthy helps maintain muscle tone and a healthy weight.
Don't spend too much time sitting or standing for long periods of time. I always advise my patients that if they're standing for a living, find five or 10 minutes once an hour to sit down and rest. Similarly, if you're sitting for a living, find five or 10 minutes an hour to get up and walk around your desk. It's pretty easy to get in 50 to 100 steps in just a few minutes.”
Are compression stockings or other conservative treatments effective?
Dr. Terpstra: “Compression stockings are not appropriate for vulvar varicosities as they are generally used for varicose veins of the legs basically from the hip down. Specific sling-type garments, like our grandmother's girdles, can be worn because they offer a pelvic lift.
While compression stockings are not appropriate in this case, we recommend using both garments if there are vulvar varicosities and varicose veins in the legs. But this is rare.”
When is surgical intervention recommended for treating severe or persistent vulvar varicosities?
Dr. Terpstra: “The best option for treating vulvar varicose veins is sclerotherapy. That's an injection of a sclerosing medication into the veins themselves. The medication causes the veins to get a little bit inflamed and shut down so that no more bad blood is flowing through them. The body then absorbs the medication.”
Do vulvar varicosities typically resolve on their own after pregnancy, or is additional treatment often needed?
Dr. Terpstra: “Within the first six weeks after the pregnancy, those veins will become involute or disappear and may not bother the woman again until another pregnancy occurs. If they do return, then other interventions are available.”
What kind of doctor should a woman with vulvar varicose veins consult?
Dr. Terpstra: “OB-GYN is a great place to start, as is a qualified vein specialist. I don't know many obstetrician-gynecologists who will treat vulvar varicose veins, but vein specialists absolutely will. However, if you make an appointment with a vein specialist, asking if that provider treats vulvar varicosities is essential because not all vein specialists do. It does require a little bit of additional medical knowledge and a willingness to see those patients.
My advice is to come see me in Chicago. It's a great city when it's not snowing!”
Vulvar varicosities: Center for Vein Restoration can help
While vulvar varicosities can be an uncomfortable and often ignored condition, it's reassuring to know that effective treatment options are available. As Dr. Terpstra explained, seeking care from a qualified vein specialist or OB/GYN with experience treating this issue is crucial. With proper evaluation and management, whether through conservative approaches like lifestyle modifications or minimally invasive procedures like sclerotherapy, many women can find relief from the symptoms of vulvar varicose veins.
Center for Vein Restoration (CVR) provides accessible, compassionate, and effective vein care. As America's largest physician-led vein center, CVR offers comprehensive treatment for chronic venous insufficiency. With 110+ centers in 22 states and 70+ active physicians, CVR boasts a 98 percent patient satisfaction rating.
Call 240-965-3915 to speak to a Patient Services Representative or schedule your consultation online at a CVR near you today.