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Pelvic Congestion Syndrome
Pelvic congestion syndrome is chronic pain exacerbated by standing or sexual intercourse in women who have varicose veins in or near the ovaries.
Pelvic congestion syndrome is a common cause of chronic pelvic pain. Varicose veins and venous insufficiency are common in the ovarian veins but are often asymptomatic. Why some women develop symptoms is unknown.
Pelvic pain develops after pregnancy. Pain tends to worsen with each subsequent pregnancy. Typically, the pain is a dull ache, but it may be sharp or throbbing. It is worse at the end of the day (after women have been sitting or standing a long time) and is relieved by lying down. The pain is also worse during or after sexual intercourse. It is often accompanied by low back pain, aches in the legs, and abnormal menstrual bleeding. Some women occasionally have a clear or watery discharge from the vagina. Other symptoms may include fatigue, mood swings, headaches, and abdominal bloating.
Pelvic examination detects tender ovaries and cervical motion tenderness.
Diagnosis requires that pain be present for > 6 mo and that ovaries be tender when examined.
Ultrasonography is done but may not show varicosities in women when they are recumbent. Some experts recommend additional tests (eg, venography, CT, MRI) if necessary to confirm pelvic varicosities. If pelvic pain is troublesome and the cause has not been identified, laparoscopy is done.
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