Understanding Vulvar Varicosities: A Guide from a Vascular Provider

Vulvar Varicosities: Understanding the Causes and Symptoms

If you are experiencing enlarged veins on your labia, you may be suffering from vulvar varicosities. These protruding veins are a common occurrence in pregnant women but can also affect non-pregnant women. Although they can be a source of discomfort, vulvar varicosities are generally harmless and can be treated with proper care.

Below vascular providers including nurse practitioners and vascular surgeons give insight into what you must know about vulvar varicosities based on peer reviewed research and treating thousands of patients.

 

Causes of Vulvar Varicosities

In most cases, vulvar varicosities come about during pregnancy and resolve after giving birth (1). Approximately 4% of women have vulvar varicosities that either occur without being pregnant or have residual vulvar varicosities after their postpartum period.  
Increase

d pressure in the pelvic region is the main reason for vulvar varicosities. This pressure can be caused by two things. First, if blood doesn't drain properly through the ovarian vein(s), the periuterine plexi, the vessels around the uterus and pelvic floor, can become engorged. Second, the iliac vein can become compressed, which causes blood to flow in the opposite direction through collateral veins, leading to increased pressure, dilation of veins, and protrusion on the skin.

Related conditions that contribute to the occurrence of vulvar varicosities, whether pregnant or not, include the following:

• Hormonal imbalances:  Elevated progesterone levels in women cause the walls of the vein to relax which makes them more susceptible to stretching and dilating. Once stretched, the veins may not recover and return to their normal size. Increased progesterone is normal in pregnancy and can occur with other underlying conditions such as ovarian cysts or adrenal gland dysfunction.
• Increased blood volume in the vein:  Increased blood volume is normal during pregnancy but may also occur outside of pregnancy if the veins do not empty properly and pooling occurs which can increase pressure inside the vein.
• Pregnancy causes: During pregnancy there is increased pressure on the veins due to the growth of the fetus within the uterus which affects the drainage of blood from the pelvic veins. The growth of the uterus within the abdominal cavity can also increase the incidence of iliac vein compression.
• Obesity outside of pregnancy also increases the risk of iliac vein compression making proper drainage of blood from the pelvic region more difficult.(2)
• Chronic constipation:  Straining when trying to have a bowel movement increases pressure the veins which can lead to dilation of the vessels. It can also worsen pre-existing vulvar varicosities.
• Genetics:  Varicose veins, including vulvar varicosities, can be passed down from other family members such as your Mother, Father, or Grandparents. (3)

A comprehensive evaluation should be done with your physician to rule out any underlying conditions which may be contributing to the presence of vulvar varicosities.

Symptoms of Vulvar Varicosities

Vulvar varicosities can cause discomfort and pain in the affected area, especially during activities such as standing or sitting for long periods. In some cases, the veins can also lead to bleeding or itching in the genital area.

Symptoms associated with vulvar varices may include the following (4):

1. Tenderness
2. Itching or burning in the genital region
3. Swelling of the labia or suprapubic region
4. Pelvic pain or pressure, pain during or after sexual activity, frequent or painful urination.
5. Skin irritation surrounding the varicosities. In some cases, a superficial thrombus may form, causing further pain, inflammation, and irritation.

Symptoms related to vulvar varicosities are often exacerbated by prolonged standing or sitting, so managing these symptoms can include taking frequent breaks from standing, elevating your legs, using compression garments (such as stockings or shorts), taking purified flavonoid fraction (Diosmin), using ice packs on the genitalia, and maintaining a healthy BMI.

If you are experiencing any of these symptoms, it's important to speak with your healthcare provider. Diagnosis should be confirmed by a thorough examination and may include a combined effort with your vascular specialist and Ob-GYN, if applicable. Your provider may recommend testing such as an ultrasound of the varicosities and deeper pelvic veins, MRI or CT studies, or venography to confirm the diagnosis.

Diagnosis and Treatment of Vulvar Varicosities

Vulvar varicosities, or enlarged veins in the external genitalia of women, can be difficult to diagnose due to their location and the fact that they often appear during pregnancy. These protruding veins may not be visible on the surface of the skin or may not appear abnormal but can still cause discomfort and pain.

To effectively diagnose vulvar varicosities and any underlying conditions, it is recommended that a complete physical exam and ultrasound study should be done. Treatment options for vulvar varicosities include lifestyle changes, such as avoiding prolonged standing or sitting, wearing supportive undergarments, and engaging in regular exercise. Medical treatment options include the use of compression stockings, sclerotherapy, or surgery (5).

If you've been experiencing symptoms such as pain or swelling in your vulva or vaginal area, it's important to speak with your healthcare provider. Vulvar varicosities, or varicose veins in the vulva, are a relatively common condition among women, especially during pregnancy. While they may be uncomfortable, there are several diagnostic tests that can help determine the underlying cause of your symptoms and guide treatment.

A collaborative effort between your OB-GYN and vascular specialist is recommended for a thorough workup. Here are the steps involved in diagnosing vulvar varicosities:

1. History and Physical Exam - Your healthcare provider will start by taking a detailed history of your presenting concerns. This may include reviewing your chief concerns, associated symptoms, personal history, and family history. Your OB-GYN will perform a thorough external exam of any visible varicose veins in the vulva. They may also complete an internal exam to see if any visible varicose veins are present within the vagina. Your vascular specialist will complete a thorough physical exam of external varicose veins on the labia and evaluate for the presence of varicose veins on the lower extremities.
2. Diagnostic Testing - Several diagnostic tests can be used to evaluate for the underlying causes of vulvar varicosities. These include:

• Ultrasound: This is a non-invasive study that uses sound waves and an ultrasound probe. It may be ordered to evaluate for incompetent superficial veins and for other deeper underlying causes such as pelvic congestion syndrome and/or iliac vein compression.

• CT scans: This is a non-invasive X-ray type imaging that can evaluate the structures within the abdominal and pelvic region. Specific types of CT scans can visualize blood flow patterns through the veins in that region.

• MRI: Magnetic Resonance Imaging is a non-invasive imaging that can also visualize the structures in the abdominal/pelvic region as well as the blood vessels and blood flow in that region.

• Venography: This is an invasive study with direct access to the veins and injection of a contrast media which shows the blood vessels and blood flow via X-ray imaging. This is typically recommended after non-invasive studies are completed

     3. Rule Out Other Conditions - 

Your healthcare provider may also want to rule out other conditions that could cause localized swelling and pain in the vulva, such as underlying STDs or Bartholin’s Gland Cysts.

It's important to keep in mind that vulvar varicosities are a relatively common condition and can be effectively managed with proper diagnosis and treatment. By working collaboratively with your healthcare provider team and undergoing the necessary diagnostic testing, you can take the first step towards finding relief from your symptoms.

While vulvar varicosities can be uncomfortable and even painful, there are steps you can take to manage the symptoms. By working with your healthcare provider, you can find the right diagnosis and treatment plan for your individual needs.

In conclusion, vulvar varicosities are a common condition among women that can cause discomfort and pain in the affected area. However, they can be easily diagnosed and treated with proper care. If you are experiencing symptoms of vulvar varicosities, it is important to consult with a healthcare professional for a proper diagnosis and treatment plan.

Vulvar varicosities can be a source of discomfort and concern for many women, especially during pregnancy. In this blog post, we will discuss effective ways to prevent and treat vulvar varicosities. From lifestyle changes to medical interventions, there are various options available to manage this condition. Let's explore them in detail.

Treatment Options for Vulvar Varicosities

1. Conservative management: This approach focuses on reducing pooling and pressure within the veins. It includes elevating the legs, taking frequent rest periods from prolonged sitting or standing, maintaining a healthy BMI, engaging in routine exercise, using compression garments, and considering supplements that promote vein health.

2. Sclerotherapy: This minimally invasive procedure involves the injection of a medication directly into the affected vein, causing it to shrink and eventually fade away.

3. Embolization: A minimally invasive procedure where a device and/or medication is placed inside the vein(s) to block blood flow, promoting the closure of the varicosities.

4. Phlebectomy: In cases where vulvar varicosities are more severe, phlebectomy may be recommended. This procedure involves the removal of the affected vein by making small incisions along its course, improving blood flow and reducing symptoms.

5. Treatment of underlying conditions: Sometimes, vulvar varicosities may be associated with other underlying conditions, such as iliac vein compression or pelvic congestion syndrome. Treatment for these conditions may involve stent placement or embolization of internal pelvic varicosities.

It's important to note that despite treatment, vulvar varicosities may recur with subsequent pregnancies. Close monitoring and discussing your options with a healthcare professional are essential for effective management.'

Prevention of Vulvar Varicosities

1. Maintain a healthy BMI: Keeping your body mass index within a healthy range reduces the risk of developing vulvar varicosities. Excess weight puts additional pressure on the veins, increasing the likelihood of varicose veins in the vulvar area.

2. Engage in routine exercise: Regular physical activity, such as walking or swimming, promotes healthy blood circulation and strengthens the muscles that support the veins. Consult with your healthcare provider to determine suitable exercises for your situation.

3. Use compression garments: Wearing compression garments, such as knee-high socks, thigh-high stockings, or specialized undergarments designed for pregnancy, can help improve circulation and alleviate pressure on the veins.

4. Monitor weight gain during pregnancy: During pregnancy, it's important to maintain a healthy weight gain recommended by your obstetrician. Excessive weight gain can contribute to the development or worsening of vulvar varicosities.

Vulvar varicosities can be prevented and treated using a combination of lifestyle modifications, conservative measures, and medical interventions. Maintaining a healthy weight, engaging in regular exercise, using compression garments, and considering appropriate treatment options can help alleviate symptoms and improve your quality of life. If you are experiencing vulvar varicosities, consult with your healthcare provider to determine the best approach for your situation. Remember, you're not alone, and there are solutions available to help you manage this condition effectively.

Complications of Vulvar Varicosities

Vulvar Varicosities typically come about with pregnancy and then resolve, however, in cases where vulvar varicosities present outside of pregnancy, other complications may be associated with them.

Pain and discomfort which may include burning, itching, a feeling of fullness or increased pressure of the labia or within the vagina is common.  These symptoms are typically worse after long periods of standing or sitting and may also be associated with sexual activity. Pain and other discomforts can be reduced or treated with the use of compression garments(stocking, pantyhose, or shorts), application of cold compresses, use of topical creams(hydrocortisone, Benadry, etc) to reduce swelling and relieve itching, limiting prolonged periods of standing/sitting, leg elevation and use of over the counter pain relievers as needed.

Skin irritation or ulceration may occur locally at the site of vulvar varicosities.  This comes about due to the increased pressure within the vein and from a blood product known as hemosiderin which can deposit in the skin surrounding the varicosities causing irritation.

Blood clots may form in the presence of vulvar varicosities.  Blood clots that form can either be superficial venous thrombus (SVT) or deep venous thrombus (DVT).  In the case of SVT, there may be localized pain, skin irritation, warmth, and redness.  The presence of a SVT is most often non-life threatening and treating the associated symptoms is key.  Although rare, DVT and/or PE(pulmonary embolism) can also be associated with vulvar varicosities. You should seek immediate medical attention if DVT/PE is suspected. Symptoms may include increased pain, warmth, redness, swelling, chest pain, or shortness of breath.

Conclusion

In conclusion, vulvar varicosities can occur during pregnancy and outside of it, causing symptoms such as chronic pain, itching, and swelling. To reduce the risk, maintain a healthy BMI, exercise regularly, avoid prolonged sitting/standing, elevate your legs, use compression garments, and consider vein health supplements.

A collaborative approach is taken to treat this condition so an early diagnosis and treatment are crucial, so consult your OB-GYN if you experience symptoms. Treatment options may be limited during pregnancy, but conservative measures can help manage symptoms. A vascular specialist can perform their own tests and treatment options depending on the severity of the case and other factors. 

Outside of pregnancy, lifestyle modifications, compression garments, sclerotherapy, embolization, and venography with stent placement may be considered. Despite treatment, vulvar varicosities may recur, especially with subsequent pregnancies. Stay proactive and seek ongoing care from your healthcare provider for effective management.

Sources: 

(1) Robert, M., Giroux, L., & Pugash, D. (2015). Diagnosis and management of vulvar veins in pregnancy. Journal of Obstetrics and Gynaecology Canada, 37(11), 1008-1018. doi: 10.1016/s1701-2163(15)30208-9

(2) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3504322/

(3) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6490943/

(4) Chia, Y. N., Loh, F. K., Tan, K. T., & Khoo, J. J. (2018). A prospective observational study of vulvar varicosities in pregnancy: prevalence, clinical features, and risk factors. International Journal of Women's Health, 10, 385-390.

(5) Kanter, G. & Whelan, C. (2019). Vulvar varicosities: evaluation and management. American Journal of Obstetrics and Gynecology, 220(6), 559-563. doi: 10.1016/j.ajog.2019.01.235