Pelvic Congestion Syndrome
The pelvis is drained through the internal, external and common iliac veins and pelvic congestion syndrome (PCS) occurs when there is abnormal dilation of the veins which drain the pelvis. The presence of varices of the pelvic veins often from a combination of endocrine and mechanical factors which leads to venous stasis and congestion of the pelvic organs causing pain. The majority of cases are found in the ovarian veins(1,2).
- Premenopausal women with >1 child
- Childhood psychological disturbances
- Childhood abuse
- Lower libido
A cardinal clinical sign is ovarian tenderness elicited during a vaginal exam due to compression of the ovarian vein. The combination of post coital ache and ovarian point tenderness helpful is ruling in PCS. For a diagnosis to be made veins in the pelvic must be enlarged and have poor flow through dynamic imaging and computerized tomography(2).
Questions to ask your patient include whether the pain exacerbated by increased intra-abdominal pressure such as standing and lifting. Ask about type and location of pain which tends to be a dull ache and unilateral. Pain often disappears after menopause. There is often an increase of pain during pregnancy if relevant for the patient. Ask about increased pain during the menstrual cycle and following coitus. How long does the pain take to subside (typically it can take several hours)? Do you experience perineal heaviness, bladder instability, backache and excessive vaginal discharge(2)?