Vulvar varicosities are swollen, twisted veins that develop on the outer genital area (the vulva). They work exactly like varicose veins in the legs, but they appear on the labia or surrounding tissue instead. Most cases show up during pregnancy and resolve on their own after delivery, though they can occasionally develop outside of pregnancy too.
Why They Develop
The vulva has a rich network of veins that drain blood back toward the heart. When pressure in the pelvic region increases, these veins can stretch, pool with blood, and become visibly swollen. Two overlapping changes during pregnancy drive this process.
First, blood volume rises dramatically to support the growing fetus. Your veins have to work harder to push all that extra blood upward against gravity, and sometimes they simply can’t keep up. Blood pools in the pelvic veins, and the smaller veins of the vulva swell as a result. Second, pregnancy hormones (particularly progesterone) relax the walls of blood vessels. The vein lining becomes stretchier and less able to contain the blood flowing through it. Combined with the weight of the uterus pressing down on pelvic veins, the result is veins that bulge, twist, and become visible under the skin.
What They Look and Feel Like
Vulvar varicosities typically appear as soft, bluish or purplish, rope-like bulges on one or both sides of the labia. Some are small enough that you might only notice them by touch. Others are clearly visible and can look alarming, especially if you weren’t expecting them. They tend to become more prominent after standing for long periods or toward the end of the day, when gravity has been working against your veins for hours.
Not everyone with vulvar varicosities has symptoms. When symptoms do occur, they commonly include a feeling of fullness, heaviness, or pressure in the vulvar area. Some people describe aching, throbbing, or a dull pain that worsens with prolonged standing, walking, or sexual activity. The area may feel swollen or tender to the touch. Itching around the affected veins is also common. In many cases, lying down or elevating the hips brings noticeable relief because it takes the pressure off the pelvic veins.
Who Gets Them
Pregnancy is by far the most common trigger, particularly in the second and third trimesters when blood volume peaks and the uterus is large enough to compress pelvic veins. The risk increases with each subsequent pregnancy because the vein walls have already been stretched once and are more prone to dilating again. Having varicose veins in the legs, a family history of varicose veins, or carrying multiples all raise the likelihood.
Outside of pregnancy, vulvar varicosities can develop as part of pelvic congestion syndrome, a condition where the larger veins deep in the pelvis become chronically dilated and allow blood to flow backward. This creates sustained pressure on the smaller veins of the vulva, pelvis, and upper thighs. Pelvic congestion syndrome is more common in people who have had multiple pregnancies, but it can also occur independently.
How They Affect Pregnancy and Delivery
Vulvar varicosities can look concerning, but they rarely cause complications during labor. The increase in blood flow to the pelvic region during pregnancy is what causes them, and the same blood flow changes reverse after delivery. Vaginal birth is generally safe with vulvar varicosities. Significant bleeding from these veins during delivery is uncommon because the veins are low-pressure vessels, and any minor bleeding is typically easy to manage.
Your care team will be aware of the varicosities and can take precautions, such as avoiding unnecessary pressure on the area and monitoring for any unusual bleeding. Blood clots in vulvar varicose veins (superficial thrombosis) can happen but are rare. If a vein suddenly becomes hard, very painful, or warm to the touch, that warrants prompt evaluation.
Postpartum Resolution
For most people, vulvar varicosities shrink significantly within weeks of giving birth. Once blood volume drops back to normal and hormonal levels stabilize, the veins lose the excess pressure that was keeping them dilated. By about six weeks postpartum, many varicosities have disappeared entirely or become barely noticeable. In some cases, particularly after multiple pregnancies, the veins don’t fully resolve and may persist as a long-term issue.
Managing Discomfort
Since most pregnancy-related vulvar varicosities are temporary, management focuses on reducing symptoms rather than eliminating the veins. A few strategies help:
- Pelvic support garments: Specialized compression garments designed for vulvar support (sometimes compared to a female version of a jock strap) apply gentle pressure to the vulvar area. These are adjustable for customizable compression and can meaningfully reduce the feeling of heaviness and aching during daily activity.
- Cold compresses: Applying a cold pack wrapped in a cloth to the vulvar area for 15 to 20 minutes can temporarily reduce swelling and relieve pain.
- Position changes: Avoiding prolonged standing or sitting helps prevent blood from pooling. Lying on your left side takes pressure off the large vein that returns blood from your lower body to your heart, improving circulation through the pelvis.
- Gentle movement: Light exercise like swimming or walking encourages blood flow back toward the heart without putting excessive strain on pelvic veins. Avoid heavy lifting or anything that significantly increases abdominal pressure.
- Elevation: Resting with your hips slightly elevated on a pillow can ease symptoms when they flare.
Treatment for Persistent Cases
When vulvar varicosities don’t resolve after pregnancy, or when they develop as part of pelvic congestion syndrome, medical treatment may be considered. Foam sclerotherapy is one option that has shown reasonable effectiveness for varicose veins of pelvic origin. In this procedure, a foaming solution is injected directly into the affected veins under ultrasound guidance, causing them to collapse and eventually be reabsorbed by the body. It’s minimally invasive and doesn’t require general anesthesia.
For cases linked to pelvic congestion syndrome, treatment sometimes targets the larger dysfunctional pelvic veins feeding the problem. However, newer approaches can treat the vulvar veins directly without addressing the deeper pelvic veins, which simplifies the procedure for some patients. The right approach depends on where the underlying vein dysfunction is and how severe the symptoms are.