Vulvar varicose veins, also called vulvar varicosities or vulval varices, are swollen, twisted veins on the vulva. They are most often seen in pregnancy, but they can also appear or persist in women who are not pregnant. When they do, they are often a sign of faulty veins deeper in the pelvis. This guide explains what they look like, why they happen, whether they are dangerous and what can be done.
What are vulvar varicosities?
They are varicose veins on the external genitals. They usually sit on the outer lips (labia majora), and sometimes on the inner lips. They can spread to:
- The upper inner thigh
- The area between the vagina and anus (perineum)
- The buttock or back of the thigh
They are caused by blood pooling in veins whose valves no longer work, just like varicose veins in the legs.
What they look like
Many people search for pictures, but appearance varies. Typical features are:
- Soft, bluish or purple veins under the skin
- A lumpy, rope-like or “bag of worms” feel
- Swelling that is bigger after standing and smaller after lying down
- Sometimes one side only
Not every lump on the vulva is a vein. Cysts, swollen glands, a hernia or, rarely, a growth can look similar. A doctor can usually tell the difference by examining you, sometimes with an ultrasound scan.
Symptoms
Some vulvar varicose veins cause no symptoms. When they do, women describe:
- Heaviness, fullness or pressure in the vulva
- Aching or throbbing, worse after standing or walking
- Itching or a burning feeling over the veins
- Pain or discomfort during or after sex
- Symptoms that flare before or during a period
Many women also feel self-conscious about how the veins look. That is a valid reason to seek advice.
In pregnancy
Pregnancy is the most common time for these veins to appear. Higher blood volume, hormones that relax vein walls and pressure from the growing womb all play a part. Most improve within weeks or months of birth.
Pregnancy-related veins have their own page: see vulval varicose veins in pregnancy.
Vulvar varicose veins when not pregnant
When the veins persist after pregnancy, or appear in women who are not pregnant, the cause is often reflux in the pelvic veins. Blood flows backwards down the ovarian or internal iliac veins, then “escapes” through small connecting veins to the surface of the vulva and thighs. Doctors call these escape points.
This is why vulvar varicosities are linked to pelvic congestion syndrome. Some women have both visible vulval veins and a dull pelvic ache that is worse after standing. Others have visible veins with no pelvic pain at all.
Other causes include:
- Varicose veins in the legs that connect up into the groin
- A narrowed vein in the pelvis, such as in May-Thurner syndrome
- Rare vein malformations present from birth
After menopause
Vulvar varicose veins often shrink and become less troublesome after menopause, as oestrogen levels fall. Some persist, particularly if there is ongoing pelvic reflux.
Any new lump, swelling or skin change on the vulva after menopause should be checked by a doctor. It is more likely to be something other than a vein, and some vulval conditions need prompt assessment.
Are vulvar varicose veins dangerous?
Usually not. They are mainly a problem of comfort, confidence and sex life. Possible complications include:
- A clot in a surface vein (superficial thrombophlebitis). The vein becomes hard, red and tender. It is not usually serious, but see a doctor, especially if it is large or near the groin.
- Bleeding. This is uncommon and usually follows injury, such as shaving. Press firmly with a clean pad and lie down. Seek urgent help if it does not stop.
How they are assessed
A doctor will ask about your pregnancies, periods, pelvic pain and leg veins, and examine you, ideally standing as well as lying down.
If there may be a pelvic source, a duplex ultrasound can show which veins are refluxing. It often includes the legs and the pelvis, sometimes with a probe inside the vagina. CT or MR scans, or an X-ray of the veins (venogram), may be used if treatment is planned. See how pelvic vein problems are diagnosed.
Treatment options
Small veins that cause no trouble do not need treating. For symptoms, options include:
- Self-care. Support underwear or compression shorts, cool compresses, avoiding long periods of standing, and lying down with hips raised when the ache builds.
- Sclerotherapy. A solution or foam is injected into the veins to close them. This is often used for isolated vulval veins.
- Removing veins (phlebectomy) through tiny cuts, for larger surface veins.
- Treating the pelvic source. If faulty pelvic veins are feeding the vulval veins, closing them from inside (embolisation) may be considered, sometimes combined with sclerotherapy.
Most evidence for these treatments comes from small studies, and there are no large trials comparing them. Treating only the surface veins may lead to recurrence if a pelvic source is left untreated. Read more in our guide to treatment for varicose veins in the vulva.
Day-to-day comfort
Simple measures can make the veins less troublesome while you decide on treatment:
- Wear firm, well-fitting underwear or cycling-style shorts to support the area.
- Avoid very tight clothing that presses on the groin.
- Take short breaks to sit or lie down during long days on your feet.
- Use a cool, wrapped pack for throbbing or swelling.
- Take care when shaving or waxing over the veins.
- Use extra lubrication and try positions that are more comfortable if sex is painful.
Can they come back after treatment?
Yes, they can. New veins may develop over time, especially with later pregnancies or if a pelvic source has not been treated. This is one reason why a scan to look for pelvic reflux is worth considering before treating larger or recurring vulval veins.
A Singapore vascular surgeon’s patient guide explains how vulval veins fit into the wider picture of pelvic vein disease.
When to see a doctor
See a doctor if vulval veins are painful, getting bigger, affecting sex, or still present several months after pregnancy, or if you also have a dull pelvic ache that worsens with standing. Our pelvic symptom check can help you prepare. Always get a new vulval lump checked.
Get urgent medical help for heavy bleeding from a vein that does not stop with firm pressure, a hot, swollen, painful leg, sudden breathlessness or chest pain, or sudden severe pelvic pain. In Singapore, call 995 in an emergency.
Frequently asked questions
Can you get vulvar varicose veins when not pregnant?
Yes. Outside pregnancy they are often a sign that blood is flowing backwards in pelvic veins, such as the ovarian or internal iliac veins, and escaping to the surface. They can also appear alongside leg varicose veins.
Do vulvar varicose veins go away after menopause?
They often get smaller and less painful after menopause, as oestrogen levels fall. Some persist. A new lump or swelling on the vulva after menopause should always be checked by a doctor, because it may not be a vein.
Are vulvar varicose veins dangerous?
Usually not. They can be uncomfortable and affect confidence and sex. Occasionally a clot forms in one of the veins, causing a hard, tender lump. Clots in surface veins are not usually serious, but they should be checked.
Can vulvar varicose veins bleed or burst?
It is uncommon. A vein may bleed if it is cut or injured, for example during shaving. Press firmly on it with a clean pad and lie down. If bleeding is heavy or does not stop, seek urgent help.
What do vulvar varicose veins look like?
They look like soft, bluish or purple, lumpy or rope-like veins on the labia. They may spread to the inner thigh, the area between the vagina and anus, or the buttock. They tend to look bigger after standing and smaller after lying down.
Sources and further reading
- Radiopaedia — Vulvar varices
- Interventional treatment of labial varices. Semin Intervent Radiol 2023
- Lopez AJ. Female pelvic vein embolization: indications, techniques, and outcomes. Cardiovasc Intervent Radiol 2015
- CIRSE — Pelvic congestion syndrome (patient information)
- Cleveland Clinic — Pelvic congestion syndrome
This article is general information, not personal medical advice. Please speak to a doctor about your own symptoms. How we create our content.