How to cope with vulvar varicosities in pregnancy

Short on time? Then the key things to know are:

• Vulvar varicosities are varicose veins found in the vulvar, which look almost exactly like those seen on the legs
• They can affect up to 22% of women and occur due to increased blood volume in pregnancy
• You can still exercise and have a normal labour with vulvar varicosities
• Applying ice, wearing compression underwear and sitting down when possible can help to reduce symptoms
• A specialist pelvic health physio can help you to look after your pelvic floor and cope with vulvar varicosities

What are vulvar varicosities?

Vulvar varicosities are not often spoken about and are often under diagnosed or even misdiagnosed. They are essentially varicose veins, generally found in the labia, just like varicose veins in the leg.

How common are they?

We are unsure on how many women truly suffer with vulvar varicosities, purely because some women don’t seek help, or their condition is mis-diagnosed. It is reported that anywhere from 9% up to 22% may be affected.

Why do vulvar varicosities appear during pregnancy?

Our heart works hard pumping blood around the body via blood vessels, and in pregnancy it works extra overtime, due to an increase in blood volume required to grow a baby. This blood returns to the heart via ‘veins’ which are tubes with one-way valves. These one-way valves are also helped along via contractions of our muscles - particularly our calf (leg) muscles to push the blood back up to the heart. Veins are generally blue-ish in colour and can sometimes be less effective.

Veins anywhere in our body can have a faulty valve or can get overstretched, so the blood starts to pool in that area instead of being pumped away. This is when ‘varicosities’ form.

How do you get diagnosed with vulvar varicosities?

An obstetrician-gynaecologist should be able to diagnose your condition, and your pelvic physiotherapist will be able to support you with management techniques. Vulvar varicosities could also be a sign of other vascular issues or Pelvic Congestion Syndrome (chronic pelvic pain), so it is worth checking in with your doctor if you suspect that you have this condition.

What do vulvar varicosities look like?

Vulvar varicosities are not to be confused with general swelling of the vulval area which is totally natural in pregnancy, due to the increased blood flow.

They look like blue ‘squiggly’ lines and often cause a change of colour in the vulva itself which is generally closer to the back (towards the anus and rectum) than the front. Some women report that the skin colour looks different to usual, that it can be just on one side and can also seem just like a swelling.

What are the symptoms of vulvar varicosities?

Some people find they have a dragging or heaviness sensation if they’ve been on their feet all day, and pain during or after intercourse is also common. Itchiness around the area is also often described and that the varicosity can feel like a ‘scrotum’ or extra enlargement of skin.

What can help with vulvar varicosities?

You don’t have to put up with discomfort! There are a few things you can try to ease the aching and swelling of vulvar varicosities:

• Apply ice every 15 mins per hour. This reduces blood flow via vasoconstriction (narrowing the veins) to reduce swelling. Always wrap ice in a towel to avoid direct skin contact.
• Get off your feet if you can - give yourself regular short breaks to sit if possible.
• Sit on a pregnancy ball when you can - this gives light pressure to the area to ease discomfort.
• Wear compression underwear. This option is not for everyone; it can be awkward to find a support garment that fits and is still comfortable around your bump, but it really is worth a try.
• Try positions that take the pressure off to help blood flow such as laying on your back with feet resting on a chair (only recommended for low-risk pregnancies and those who are under 28 weeks pregnant) and kneeling on the floor with your upper body resting over a chair.

Things your pelvic physiotherapist can guide you on to help:

• Learning to relax your pelvic floor muscles - muscles in a ‘tight’ state can impair blood flow
• Show you how to self release tightness around the area

Will my vulvar varicosities affect my labour?

No! Rest assured that this condition will not prevent you from having a vaginal delivery as incidence of vein rupture (bleeding) is rare. Learning how to relax your pelvic floor before birth is an extremely effective way of minimising pressure.

Your pelvic physio should be able to guide you on how to safely prepare your pelvic floor for birth, despite having vulvar varicosities.

What can’t I do?

You should not use perineal stretching balloons like the Anniball or Epino-UK to prepare for birth.

Can I still exercise with vulvar varicosities?

Absolutely! You need to listen to your body and not push through feelings of dragging or heaviness. It is likely you will need to modify your usual activities, but this does not mean you should stop them altogether. Again, your pelvic physiotherapist can guide you on this.

Get support from a pelvic health specialist

If you are struggling with your antenatal journey, then please access healthcare support so you can get the right guidance.

There are several treatment options available to you. Speak to one of our women’s health physiotherapists, or [private midwives] (https://naytal.uk/services/midwife) at Naytal for personalised support.

If you find you are struggling with low mood due to your symptoms, our mental health counsellors can also help you.

References

Durham, J & Machan, L. (2013). Pelvic Congestion Syndrome. Seminars in interventional radiology. 30. 372-380. 10.1055/s-0033-1359731

Gavrilov SG. Vulvar varicosities: diagnosis, treatment, and prevention. Int J Womens Health. 2017 Jun 28;9:463-475. doi: 10.2147/IJWH.S126165. PMID: 28721102; PMCID: PMC5500487

NHS (2020). Common health problems in pregnancy. [online] nhs.uk. Available at: https://www.nhs.uk/pregnancy/related-conditions/common-symptoms/common-health-problems/ ‌