Vulval varicose veins (or alternatively vulvar varicose veins) are an often overlooked but significant condition affecting many women. This article explores what they are, their causes, symptoms, and treatment options. It also highlights the important research by Professor Mark Whiteley and The Whiteley Clinic, which has advanced the diagnosis and management of this condition.

Research from The Whiteley Clinic has shown that approximately 1 in 7 women who suffer from leg varicose veins, are affected. However, many of these veins remain hidden until pregnancy or until leg varicose veins recur despite previous surgery or other treatments. This condition, although common, often goes unnoticed and untreated.

What Are Vulval Varicose Veins (aka: Vular Varicose Veins)?

Vulval varicose veins refer to enlarged, swollen veins located in the vulva, the external female genital area. These veins can appear visibly bulging and often bluish in colour, but sometimes lie deeper beneath the surface, making them less obvious. About 15–20% of women have visible varicose veins in their legs, and another 15–20% have “hidden varicose veins” that are too deep to be seen but can still cause discomfort. Similarly, this condition can lead to aching, swelling, skin irritation, and other problems.

Causes and Underlying Issues

Vulval varicose veins primarily develop due to venous insufficiency in the pelvic veins. In this condition, the valves in pelvic and vulval veins fail to function properly. This failure allows blood to flow backward (reflux), leading to pooling and vein enlargement. The main causes and contributing factors include:

• Pregnancy: The most common cause. Increased blood volume and pressure on the pelvic veins during pregnancy often trigger vulval varicose veins. Hormonal changes also relax vein walls, worsening reflux. In later pregnancy, the size of the foetus also pushes blood out of the pelvic veins, increasing the size of the vulval varicose veins.


• Pelvic Congestion Syndrome (PCS): A condition where pelvic veins become dilated and congested due to faulty valves or obstruction, causing chronic venous insufficiency and associated symptoms (see below). It is a major underlying cause of vulval varicose veins.


• Genetic predisposition: Family history of varicose veins with the associated weak vein walls increases risk.


• Hormonal influences: Hormones such as progesterone during pregnancy or menstruation reduce vein tone and elasticity, promoting vein dilation.


• Obstruction of pelvic veins: Compression of veins (e.g., May-Thurner syndrome, nutcracker syndrome) can lead to increased venous pressure and varicosities, although research has shown that this is often overdiagnosed and over-treated, and is actually quite uncommon (Watch the Video).

• Powerlifting: The sudden straining of lifting very heavy weights can lead to both vulval varicose veins and also haemorrhoids. It is thought to be the sudden increase of pressure caused when the person suddenly strains to lift a massive weight.


• Previous pelvic surgery or trauma: Can damage veins or valves, impairing blood flow.


• Prolonged standing or increased intra-abdominal pressure: Jobs or conditions that increase pressure can contribute to vein valve failure.

A clear understanding of these underlying causes is essential for making the right diagnosis and choosing the most effective treatment.

Pelvic Congestion Syndrome and Its Connection to Vulval Varicose Veins

PCS / PeVD, formerly known as Pelvic Congestion Syndrome, is a key underlying cause of vulval varicose veins. PCS / PeVD occurs when the pelvic veins become dilated and dysfunctional due to valve failure or mechanical obstruction, leading to venous reflux and increased venous pressure in the pelvis.

Women with PCS / PeVD often experience:

• Ongoing pelvic pain, typically aggravated by being upright or during/after sex


• Vulval swelling


• Lower limb varicose veins that recur despite treatment


• Associated symptoms like urinary frequency or heaviness in the pelvis


• Irritable bowel syndrome


• Low back pain


• Hip pain

The pathology arises from reflux in the ovarian veins, internal iliac veins, or other pelvic tributaries. Obstruction syndromes such as May-Thurner or nutcracker syndrome can exacerbate this condition by increasing venous pressure, although research from The Whiteley Clinic and now elsewhere has shown these syndromes to be frequently overdiagnosed and over-treated.

Diagnosis of PCS requires detailed imaging, with transvaginal duplex ultrasound, using the Holdstock-Harrison protocol, being the most effective tool. It reveals reflux and dilated veins, guiding targeted treatments.

Treatment focuses on the combination of both:

• Pelvic vein embolisation: Blocking refluxing veins with coils to reduce venous pressure.


• Foam sclerotherapy: Adjunctive therapy to close abnormal veins.

These interventions alleviate symptoms, reduce vulval varicose veins, and improve quality of life. Thanks to The Whiteley Protocol®, treatments are typically carried out under local anaesthetic in a walk-in, walk-out setting. This approach reduces symptoms effectively and avoids the need for major surgery.

Why Vulval Varicose Veins Are Often Missed

Women with vulval varicose veins face several challenges:

• Many find it difficult to discuss symptoms due to embarrassment.


• Non-specialist healthcare providers, including some doctors and midwives, may not be aware of the condition or effective treatments. Indeed, many midwives who see them in pregnancy give the incorrect advice that they “disappear after the child is born”. They don’t! They just get smaller and less noticeable, but they continue to deteriorate.

As a result, vulval varicose veins are often underdiagnosed or misdiagnosed, delaying proper care.

Do They Really Need Treatment and Why Sooner Is Better?

If left untreated, vulval varicose veins can sometimes lead to more serious complications. To begin with, many women may develop chronic pain and persistent discomfort. Over time, ongoing aching and swelling can interfere with daily activities and significantly reduce quality of life. In addition, long-standing venous insufficiency may result in noticeable skin changes, such as discolouration, eczema, and skin thickening.

However, one of the biggest problems of vulval varicose veins is the psychological impact. These symptoms may lead to feelings of embarrassment and distress, impacting both mental well-being and close personal relationships. In the most severe cases, the varices can become huge, making the risk of vaginal delivery dangerous. Timely action by medical teams helps prevent serious health issues, lessen discomfort, and support sustained health over time.

Read more: Quality of Life After Venous Treatment

Expertise behind the Treatment of Vulval Varicose Veins

Since the early 2000s, research led by Professor Mark Whiteley has significantly advanced the understanding and management of varicose veins and pelvic vein reflux. Over time, his team at The Whiteley Clinic has developed refined diagnostic and treatment methods. As a result, these approaches are now recognised internationally for their effectiveness and innovation.

With their professional approach, women experiencing symptoms such as vulval swelling, discomfort, or visible veins can access specialised care tailored to their individual needs. Therefore, patients are provided with better diagnostic accuracy and treatment approaches that yield positive outcomes.

The Whiteley Clinic continues to apply the latest medical technologies and research findings to provide effective and minimally invasive treatments.
This long-standing expertise gives patients confidence that experienced specialists will properly investigate and manage their condition.

Conclusion

Vulval varicose veins are a common yet often under-recognised condition that can significantly affect a woman’s quality of life. For this reason, it is essential to raise awareness and seek an early diagnosis to ensure timely and effective treatment.

Women noticing symptoms like vulval swelling, aching, or visible veins should consult a vascular specialist for a thorough assessment.

Thanks to decades of research and clinical experience, expert teams such as those at The Whiteley Clinic now offer safe, effective, and personalised treatment options. As a result, healthcare professionals strongly encourage women to seek advice promptly, helping to prevent complications and improve overall well-being.

Professor Mark Whiteley has been quoted in The Telegraph, highlighting the significance of this frequently overlooked problem and the need to raise public awareness. Moreover, his team's pioneering research has played a critical role in improving both the diagnosis and treatment of the condition.

You can find the full article here if you're interested in a more detailed discussion:

Half of young women can’t ‘locate their vaginas’ - The Telegraph