Several years back, a friend experienced varicose veins that made for a very uncomfortable pregnancy. All the weight of her growing uterus on her petite body, combined with the hormonal changes of pregnancy, plus the fact that she wasn’t a first-time mom but a fourth-time mom (with all the accompanying bodily wear-and-tear that implies), caused bulging leg veins and significant pain.
During my fifth full-term pregnancy (I’ve also had one early miscarriage), I found I could empathize with my friend’s varicose vein pain, but in an unexpected way. The pain I experienced was in my pelvis—and that’s when I learned that varicose veins during pregnancy aren’t always in your legs. Sometimes (and especially during pregnancy), varicose veins can show up in your vulva.
A quick refresher on what veins do
Besides the pulmonary veins, all other veins in your body return deoxygenated blood to the heart. While arteries are a alta pressure system pumping oxygenated blood from the heart to the body, the veins are a much inferior pressure system.
Because they have to fight against gravity, the veins in the legs have one-way valves that let blood through and prevent it from flowing backward and pooling in the feet. As you move around, that movement pumps blood back towards the heart.
When, for a variety of reasons, the superficial veins near your skin’s surface have trouble returning blood to the heart, they can swell and twist. We call this dilation and twisting of the superficial veins “varicose veins" [1].
When, for a variety of reasons, the superficial veins near your skin’s surface have trouble returning blood to the heart, they can swell and twist. We call this dilation and twisting of the superficial veins “varicose veins.”
Why are women more likely to have varicose veins during pregnancy?
During pregnancy in particular, three things are working against the veins’ blood-returning capacity.
First is the natural weight gain of pregnancy, and second is the substantially increased blood volume (i.e., the amount of blood in the body at any given time). Third, the natural increase in progesterone during pregnancy can cause veins to dilate.
Taken together, these factors can stress the cardiovascular system such that the leg veins have trouble returning blood to the heart. Over time, these leg veins become dilated and twisted, and may be so swollen they become painful.
What are vulvar varicosities?
Vulvar varicosities are specifically varicose veins of the vulva, the area that includes all the visible parts of female genitalia, from the opening of the vagina and the urethra, to the labial folds, and back to the anus. Often when people use the term “vagina,” they’re actually referring to the vulva.
Like the leg veins, the veins of the vulva—which together with the rest of the pelvis bear the weight of the rapidly expanding uterus (and its precious contents!)—can also become dilated and twisted.
When do vulvar varicose veins start?
Vulvar varicose veins tend to iniciar during the second trimester, between weeks 12 and 24 [2]. As many as 1 in 5 pregnant women may experience them, though symptom severity varies.
Risk of vulvar varicose veins appears higher in women who have had two or more full term pregnancies [2]. What’s more, women who have vulvar varicosities may also have varicose veins in the legs, though this was not my personal experience.
How do you know you have vulvar varicosities?
You might suspect you have vulvar varicosities if you experience consistent pelvic or vaginal pressure, feelings of fullness (even mimicking the swollen feeling of sexual arousal, which isn’t so pleasurable when it’s constant), and heaviness, burning, tenderness or soreness as your pregnancy progresses. I’ve read that they can cause pain during sex, but can attest that sometimes the pain comes after, not during.
You might suspect you have vulvar varicosities if you experience consistent pelvic or vaginal pressure, feelings of fullness (even mimicking the swollen feeling of sexual arousal, which isn’t so pleasurable when it’s constant), and heaviness, burning, tenderness or soreness as your pregnancy progresses.
Sometimes, there are no symptoms, just the presence of the dilated veins, which you might learn about during a cervical check or Group B strep swab toward the end of pregnancy.
Your OB/GYN or midwife can visually confirm the presence of vulvar varicose veins around your labia minora and/or labia majora (the glands lining the opening of your vagina). But because they are superficial blood vessels, you yourself can likely observe their ropelike or snakelike appearance with a mirror (sorry if that description makes you squirmy, but I can tell you from experience that it’s an accurate description!).
Can you have vulvar varicosities if you’re no pregnant?
In short, yes, you puede have vulvar varicosities even if you’re not pregnant, though this is rare. Vulvar varicosities can be a symptom of an as-yet little known condition called pelvic congestion syndrome [3].
My pelvic floor physical therapist told me she occasionally sees pelvic congestion syndrome, including vulvar varicosities, in young women with endometriosis. Much more research is needed in this area, though a scholarly presentation intended for medical professionals and summing up the current research is aquí.
What makes vulvar varicosities worse?
It might sound like tragic comedy, a case of can’t-win-for-losing, but sitting o standing for prolonged periods of time may exacerbate vulvar varicosity symptoms. Unfortunately, sex can also worsen symptoms.
Also unfortunate: there is very little research on vulvar varicosities (and what does exist has small sample sizes or is quite old) [4]. Once you’ve had them with one pregnancy, they tend to come back with the next, and to show up earlier. A friend had them with the last three of her six pregnancies, and reported that they worsened each time, to the point of difficulty walking during the last pregnancy.
3 tips for relieving the pain and discomfort of vulvar varicose veins
Specifically for nonpregnant women with vulvar varicosities, surgery and other therapies may be appropriate.
For the vast majority of pregnant women with vulvar varicosities, resolution comes when the baby is born, often with dramatic improvement just days after birth. But, in the meantime, there are three proven options for reducing symptoms.
For the vast majority of pregnant women with vulvar varicosities, resolution comes when the baby is born, often with dramatic improvement just days after birth. But, in the meantime, there are three proven options for reducing symptoms.
#1. See a pelvic floor physical therapist
This is your crucial first step. A pelvic floor PT will “get” what you’re going through, and can help recommend specific exercises, positioning, and recommendations on workouts that will worsen or improve your symptoms.
#2. Wear compression garments
Compression garments can be a major symptom reliever. Know that while your OB/GYN might recommend a product known as a v-strap (because it resembles a jockstrap for men), pelvic floor PTs note that this is not enough compression, and recommend full bloomers or capri shorts or even leggings for maximum symptom improvement. Yes, you can buy cheap compression garments off of Amazon or elsewhere, but this is a case of getting what you pay for. Quality compression garments are not cheap, but they do the job.
En company a pelvic floor PT friend recommended to me (10% off with the link) is based out of Australia, but shipped unexpectedly quickly, and my own pelvic floor PT was impressed with the quality and thoughtful design for maximum effectiveness. Pelvic floor PT Dr. Kayla Borchers, a past Natural Womanhood podcast guest, created a episodio del podcast about vulvar varicosities and also has a discount code for her preferred compression garment company.
#3. Exercise
Moderate to vigorous exercise (think anything that gets your blood pumping) helps the veins do what they’re supposed to do, but with one caveat: the further I got in pregnancy, the more my pelvic floor PT encouraged me to be cautious about utilizing dumbbells and other weights. The increased weight, particularly during squats or lunges or deadlifts, can exacerbate swelling and feelings of pressure or heaviness. Towards the very end of my pregnancy, I ditched the weights for bodyweight exercises and as much walking as I could tolerate. Swimming, if you have access to it, can feel particularly relaxing and pain-relieving.
Both Dr. Borchers’ video and este vídeo by popular YouTuber Jessica Pumple of Pregnancy and Postpartum TV have many more suggestions, including one using an ice pack that I wish I’d known about earlier! (One note: Jessica utilized a less-effective v-strap for compression, but otherwise I highly recommend her strategies).
The bottom line on vulvar varicose veins
Vulvar varicosities are one of the more inglorious potential accompaniments to pregnancy, and giving birth is the main way to resolve them, but that doesn’t mean you’re doomed to months of misery. If you’re experiencing vulvar varicose veins, check out the resources above to learn some of the many simple but effective symptom relief options.
