OBJECTIVE: To assess the impact of varicose veins (VV) on generic and disease-specific quality of life (QOL). METHODS: A cross-sectional analysis performed in a cohort study based on 166 general practices and 116 specialist clinics for venous disorders in Belgium, Canada (Quebec), France and Italy included a sample of 1313 patients aged 18-75 randomly selected from a registry of 5688 consecutive patients. Generic and disease-specific QOL was measured by SF-36 and VEINES-QOL. RESULTS: In both genders, age-standardised SF-36 Mental Component Score (MCS) and Physical Component Score (PCS) were comparable in patients with VV alone (Men: PCS 47.6, MCS 46.2; Women: PCS 46.5, MCS 43.9) and in patients without VV (Men: PCS 45.6, MCS 47.2; Women: PCS 48.3, MCS 43.0). PCS declined with the severity of signs of venous disorders associated with VV; it was 42.9 (Men) and 39.4 (Women) in patients with VV and skin changes, and 37.3 (Men) and 35.5 (Women) in subjects with VV and ulcer. Similar patterns were found for VEINES-QOL. In covariance analysis adjusted for co-morbidity and other determinants of health status, an adjusted difference of -0.1 was found for both PCS and VEINES-QOL scores between patients with VV alone and patients without VV (p>0.05). Large adjusted differences in PCS and VEINES-QOL were observed in patients with VV and skin changes (differences of -3.0 and -3.1 respectively) and in patients with VV and healed/open ulceration (-5.0 and -3.8 respectively). Comparable results were found when only subjects recruited by specialists were studied. CONCLUSIONS: In patients with VV, impairment of quality of life is not associated with VV themselves but with the severity of concomitant signs of other venous disorders, such as venous oedema, skin changes or ulceration. Treatment goals in patients with VV should clearly distinguish between cosmetic improvement and improvement of QOL and symptoms.