Varicose veins, or varicosities, occur when your veins become enlarged, dilated, and overfilled with blood. In most cases, varicose veins appear on the lower legs, but when varicose veins appear in the labia or perineum, they are called vulvar varicosities. Roughly 4% of people with a vulva will experience vulvar varicosities. That number increases to about 18%–22% in pregnant people. Typically, vulvar varicosities will resolve on their own after pregnancy, and while vulvar varicosities are not always problematic, they can often cause discomfort. Let’s discuss why vulvar varicosities can occur during pregnancy and what strategies we can use to decrease discomfort and prevent them from worsening.
What causes vulvar varicosities?
Vulvar varicosities arise when the veins in your vulva struggle to circulate the blood from your lower body and pelvis back up to your heart. Some of the changes that your body goes through during pregnancy increase your chances of getting vulvar varicosities.
Increased blood volume and blood flow to your pelvis. During pregnancy, your total blood volume increases by about 30-50% and blood flow increases to the pelvis. Therefore, your veins have to do more work to carry that extra blood back to the heart. When there’s more blood to move than these veins can handle, the blood can start to pool and swell in your veins.
Hormone changes. Increases in the production of the hormone progesterone during pregnancy leads to vasodilation, or relaxation of blood vessel walls. This can promote your blood vessels to increase in diameter and blood to flow in the wrong direction, resulting in the formation of varicose veins.
Increased uterus size. As your uterus grows during pregnancy to support your growing baby, pressure on the pelvic veins and vena cava is increased. This new weight can obstruct the pelvic veins and make it harder for them to carry the blood back to your heart, leading to the backflow of blood and varicose veins.
What do vulvar varicosities look and feel like?
Some people may not notice any symptoms with vulvar varicosities, while some may notice that their vulva looks and feels different than before. This is why it is important to observe the vulva with respect and care to be aware of any changes that may be occurring.
Symptoms of vulvar varicosities can include pressure, heaviness, and/or swelling in and around the genitals, as well as vulvar pain or pressure that is worse with prolonged standing, intercourse, or physical activity. You may also see bulging or swollen veins on your vulva that appear twisted and bluish or purplish in color.
How to manage vulvar varicosities?
Although there is no way to prevent vulvar varicosities completely during pregnancy, there are strategies that you can use to reduce the discomfort they cause and prevent them from worsening.
Wear a supportive compression garment such as the V2 supporter, V-Sling, or prenatal cradle to decrease discomfort.
Elevate your pelvis and legs with pillows or a wedge to help reduce swelling and improve circulation back to your heart.
Use a slow exhale with effort such as lifting and during bowel movements to reduce the pressure and strain on your pelvic floor.
Avoid prolonged standing or sitting, as these positions strain and put downward pressure on your pelvic floor.
Apply an ice pack to the vulva for 10-20 minutes a few times a day to help reduce swelling to the area and ease pain.
Sleep on your left side to reduce pressure on the vena cava and improve blood flow back to the heart.
See a Pelvic Floor Physical Therapist! Pelvic floor physical therapists can educate you on proper mechanics and pressure management with day to day activities and exercise, advise on modifications for activities that may cause worsening of symptoms, and screen for potential pelvic floor muscle dysfunction to improve discomfort and prevent varicosities from worsening during pregnancy!
In the South Jersey area and want one on one care with the Breathe Life Team? Schedule an appointment for your complimentary 15 min phone call to see how pelvic therapy can help you!
Dr. Becca Jones, PT, DPT, CSCS, is a 2016 graduate of New York University with her Doctorate of Physical Therapy. Her passion for supporting people through their pregnancy and/or post partum journey inspired her to specialize in pelvic health. Dr. Becca believes in providing holistic, individualized care in order to restore comfort and build confidence to get people back to what they love.