Vulvar Varicosities and Pregnancy: What They Are and How to Find Relief
Pregnancy brings many changes to the body, including changes to circulation. One of the less commonly discussed changes is the development of vulvar varicosities, enlarged, swollen veins around the vulva.
Although they can look concerning and may be uncomfortable, vulvar varicosities are relatively common during pregnancy and are usually temporary.
It is estimated that approximately 18–22% of pregnant women experience vulvar varicosities. For most people, they gradually settle after birth as pregnancy-related changes in blood flow and pressure return towards normal.
What are vulvar varicosities?
Vulvar varicosities are enlarged, dilated and sometimes twisted veins in the tissues around the vulva, most commonly affecting the labia majora and labia minora.
During pregnancy, several factors can contribute to their development.
The growing uterus increases pressure on the veins that return blood from the pelvis and lower body. At the same time, pregnancy hormones cause the walls of blood vessels to become more relaxed, while overall blood volume increases.
Together, these changes can make it more difficult for blood to return efficiently from the pelvis, allowing blood to pool within the smaller veins around the vulva.
What do vulvar varicosities feel like?
Symptoms can vary considerably from person to person.
You may notice:
Pain or aching around the vulva
A feeling of heaviness, fullness or pressure
Swelling around the vulva
Visible blue or purple, bulging or tortuous veins
Itching or irritation
Discomfort that increases after prolonged standing or sitting
Increased discomfort with exercise or sexual intercourse
For some women, the veins are noticeable visually but cause very little discomfort. For others, the pressure and aching can become quite significant, particularly towards the end of pregnancy.
Why are they worse when standing?
One of the reasons vulvar varicosities can become more uncomfortable throughout the day is gravity.
When you are standing for long periods, blood has to travel upwards from the pelvis and legs against gravity. Pregnancy-related changes to the pelvic circulation can make this return more difficult.
This is why you may notice more pressure, swelling or aching after being on your feet for a long time, and why changing position or lying down can provide relief.
Movement can also be helpful because the muscles surrounding the pelvis and lower limbs contribute to circulation through their normal pumping action.
Can vulvar varicosities affect birth?
In most cases, vulvar varicosities do not prevent you from having a vaginal birth.
However, it is important to let your midwife or obstetrician know if you have significant vulvar varicosities, particularly if they are large, painful or associated with substantial swelling.
Your maternity care provider can assess the veins and consider them alongside your individual birth circumstances.
Do vulvar varicosities go away after pregnancy?
For most women, yes.
As pregnancy-related pressure on the pelvic veins decreases after birth and circulation returns towards its pre-pregnancy state, vulvar varicosities generally reduce.
Research suggests that around 4–8% of women may continue to experience vulvar varicosities into the postpartum period, although they will often continue to improve. Most pregnancy-related vulvar varicosities resolve within approximately six weeks postpartum.
If swelling, pain or prominent veins persist beyond the early postpartum period, it is worth discussing them with your GP, midwife or other appropriate healthcare professional.
What can you do to relieve vulvar varicosity discomfort?
There are several simple strategies that may help reduce pressure and discomfort.
Keep changing position
Try to avoid spending long periods sitting or standing in one position.
Gentle movement throughout the day can encourage circulation and reduce the feeling of pooling or pressure.
Keep moving
You generally do not need to stop being active because you have vulvar varicosities.
Walking, gentle mobility and pregnancy-appropriate exercise can help maintain circulation. However, if a particular activity significantly increases pain or pressure, modify it and discuss your symptoms with your healthcare provider.
Use cold therapy
A cold compress can provide temporary relief from aching, swelling and discomfort.
You can also try a padsicle — a clean maternity pad that has been cooled or frozen and then wrapped appropriately before being applied externally.
Avoid placing ice directly against the skin.
Consider supportive garments
Some women find that specifically designed maternity support garments provide additional comfort, particularly when walking or exercising.
The aim is gentle support rather than significant compression or restriction.
Rest with your pelvis supported
If your symptoms become more noticeable towards the end of the day, spending some time lying down can help reduce the effect of gravity and relieve pressure.
You may find that side-lying is particularly comfortable during pregnancy.
Pelvic floor and breathing
Your diaphragm and pelvic floor work together as part of your body's pressure-management system.
During breathing, the diaphragm moves downwards as you inhale and upwards as you exhale. The pelvic floor responds to these changes in pressure.
Rather than constantly holding or tightening your pelvic floor, learning to breathe slowly and allow the pelvic floor to move and relax may help support normal pressure changes through the abdomen and pelvis.
This can be particularly useful if you tend to brace or hold tension through your pelvic floor.
Try a warm or cool sitz bath
Some women find a sitz bath soothing for vulvar discomfort.
Temperature preference varies, so choose whichever feels most comfortable. If you have significant swelling, pain or any concerns about your symptoms, seek advice from your maternity care provider.
How can osteopathy help?
At Empower Osteopathy, the focus is not on trying to "push the veins back" or directly treat the varicose veins themselves.
Instead, an osteopathic assessment can look at the movement, pressure management and muscular tension throughout the abdomen, pelvis and surrounding structures.
Depending on your individual presentation, treatment may consider:
Pelvic and abdominal mobility
Pregnancy changes the position and mechanics of the pelvis, abdomen and uterus. Gentle manual therapy may be used to support comfortable movement through these areas.
Round ligament tension
The round ligaments extend from the uterus towards the groin and labial region. Changes in tension through the abdomen, pelvis and uterus can influence how these tissues feel during pregnancy.
Gentle techniques may be used to address areas of tension and improve comfort.
Pelvic floor function
The pelvic floor is important for both support and pressure management.
Rather than focusing solely on strengthening, pregnancy care may also involve assessing whether the pelvic floor can relax, lengthen and move with breathing.
This natural movement contributes to the pressure changes that occur throughout the abdomen and pelvis.
Inguinal and pelvic soft tissues
Tension through the groin, lower abdomen and surrounding soft tissues may contribute to feelings of restriction or discomfort.
Gentle treatment can be used to improve mobility and comfort where appropriate.
Movement and pressure management
Your osteopath can also help you understand how your posture, breathing, exercise and daily activities may influence your symptoms.
Sometimes small changes to how you move, lift, exercise or position yourself can make a meaningful difference to comfort.
When should you seek medical advice?
Vulvar varicosities are usually benign and temporary, but not every vulvar swelling or painful vein is simply a pregnancy-related varicosity.
Speak with your midwife, obstetrician or GP if you notice:
Sudden or significant swelling
Severe or worsening pain
Redness, warmth or marked tenderness over a vein
A hard or particularly painful vein
Bleeding
Symptoms that are significantly affecting your ability to walk or function
Symptoms that persist or worsen after birth
Your healthcare provider can assess whether further investigation is required.
The good news
Vulvar varicosities can be uncomfortable and sometimes alarming, but they are a recognised change that can occur during pregnancy.
For most women, they gradually improve after birth as pelvic pressure decreases and circulation returns towards normal.
In the meantime, regular movement, changing positions, appropriate support, cold therapy and good pressure-management strategies can help you stay more comfortable.
At Empower Osteopathy, pregnancy treatment is individualised to your symptoms, stage of pregnancy and birth goals. If vulvar pressure, pelvic discomfort or pelvic floor tension is making pregnancy less comfortable, an assessment can help identify ways to support movement and comfort throughout your pregnancy.
References
Fassiadis N. Vulvar varicosities in pregnancy. Journal of Obstetrics and Gynaecology. 2006.
