Clinical grading scale for varicose veins of the vulva - The Whiteley Clinic grading scale

Whenever medical people need to communicate with each other or decide on treatments, it is very useful to have a recognise grading scale for the condition.

Before 2012, there was no clinical grading scale in use for vulval varicose veins.

In early 2012, the following grading scale was published by The Whiteley Clinic, and is now used to classify the severity of any patients presenting with varicose veins of vulva:

  Description Frequency seen at present
Grade 0 Normal – no varicosities nor venous reflux in vulva Usual
Grade 1 No visible varicosities in vulva, but ultrasound proven reflux in vulval veins usually with para-vulval varicose veins seen on inner thigh Common – 1 in 7 females presenting with leg varicose veins (1 in 5 of those post vaginal delivery)
Grade 2 Visible varicosities seen through mucosa of inner labia and lower vagina and ultrasound proven reflux in vulval veins. Uncommon
Grade 3 Isolated varicosities seen on standing through skin of outer labia majora without a distortion of the general anatomy of the area Very uncommon
Grade 4 Extensive varicosities of the labia, distorting skin and distorting the gross anatomy of the area on standing Rare


If you want to see more about this scale, it was first published in:

The treatment of varicose veins of the vulva and vagina.

MS Whiteley

In: Greenhalgh RM (Ed.) Vascular and Endovascular Controversies Update. London Biba Publishing, 2012 p. 666-670

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