Vulvar varicosities - what is it?

Vulvar varicosities or varicose veins of the vulva during pregnancy is not a common topic of discussion between pregnant women, but it should be.
Estimated to affect between 4% and 10% of women during pregnancy, the actual figure

for vulvar varicosities is most likely to be much higher with many women not reporting or being diagnosed, being too embarrassed to discuss the symptoms with their health care professional.

What are the symptoms of Vulvar Varicosities?

• Varicose veins of the vulva, known as ‘vulvar varicosities’, is the swelling of the outer lips of the vagina which is caused by the blood pooling in the veins. Besides not looking very attractive, vulvar varicosities can feel uncomfortable and make the vulva ache and feel painful.
• Some women will have visible varicose veins around the vulva, inner thighs and backside but others will not show any visible signs yet exhibit other symptoms like pain.
• The most common symptoms women experience is pain around the pelvis and / or lower back usually describing it as a dull ache. The pain often gets worse through the day as both standing or sitting for long periods of time exacerbate the condition.
• Pain can also occur during sexual intercourse as well as before and during menstruation.
• Varicose veins in the pelvis can also cause the need for more frequent urination
• Finally, the emotional aspect of the condition can be an additional contributing factor in pre-natal anxiety and depression.

It’s important to note that vulvar varicosities are unlikely to cause any problems for the birth process and typically disappear on their own within about six weeks after the birth of your baby. These veins have a low blood flow so even if bleeding occurred it could easily be controlled. As always, for peace of mind and making sure that your health is in no way compromised seeing your health care professional should always be your first step, especially as you are now responsible for that precious life developing in your tummy.

What causes Vulvar Varicosities?

The risk of varicose veins is greater during pregnancy because of the increase in blood volume and decrease in how quickly your blood flows from your lower body. This puts pressure on your veins. In turn veins swell into purple/blue bulges, similar to the ones that can develop in the legs.

Here’s how it all happens due to normal changes that occur to your body during pregnancy:

1. Our veins carry blood back to the heart from all over the body. When the blood flow is against gravity, tiny valves within the veins open and close to stop the blood from flowing backwards. Sometimes, however, these valves become weak and this allows the blood to flow backward and to pool in the veins, causing varicose veins. You are familiar with varicose veins forming in the legs but these veins can also form in the pelvic area, the uterus, ovaries, vulva and vagina. Varicose veins in the pelvis are often referred to as pelvic congestion syndrome or pelvic venous flow disorder.
2. Increased blood supply to the area swells the veins.
3. The pressure of the growing baby slows the blood from moving away from the area, hence the pooling effect.

What can you do about Vulvar Varicosities?

There’s a number of things you can do to minimize the symptoms of vulvar varicosities.

1. Avoid being still for long periods of time, keep active and keep moving, walk, and change positions when sitting or lying down. Go for a swim,the water will help lift the baby and improve the blood flow from your pelvis.
2. Avoid any squatting, kneel or sit on a chair.
3. Avoid constipation which will increase the pressure on your veins during bowel movements. Make sure your bowel motions are regular, soft and easy to pass. Some tips from Mater Mother’s hospital include:

• Maintain curve in lower back lean forward from the hips
• Allow abdomen to relax forward
• Always keep breathing
• No straining
• A small footstool may enhance position (and in general assist with bowel movement) - check out the hilarious Squatty Potty video here of the company featured on Shark Tank and Dr. Oz. – just be careful not to laugh too hard, which makes point 4 above even more relevant!
• Avoid activities that cause straining such as lifting, pushing, pulling, sneezing or coughing (inc. uncontrollable laughter). When you cannot avoid any of these activities, use your hands or a rolled towel to help support your perineum.
• Lie down to rest as often as practical. Lying on your side is best.
• Practice your pelvic floor exercises regularly to make sure your muscles are strong. There’s a great video by Shira Kramer of BeActive Physio here.
• When you have varicose veins in your legs, you buy support stockings or compression socks to support the swollen veins. Unfortunately, there are no such garments for vulvas or are there? Years ago, when sanitary pads were much, much thicker, health care providers suggested that women wear a few pads for support. Today, this simply wouldn’t work, as it would take the entire pack of the modern ultra slim pads to make a difference. Not practical, comfortable or necessary, there are more suitable alternatives and many physiotherapists recommend using special support garments to assist in reducing the symptoms of vulvar varicosities. Many women get the best results when they apply garments and support hosiery before getting out of bed in the morning before gravity takes effect. 

Natural therapies to deal with varicose veins of the vulva

Some women have found some natural therapies very helpful when dealing with their vulvar varicosities but as always, err on the side of caution and check with your health care practitioner before trying any new dietary supplements, oils, herbs or compresses.