When Pelvic Pain Signals a Vascular Problem

Pelvic pain can be concerning when it persists or occurs unrelated to menstruation. For some women, pelvic pain becomes debilitating. Pain may last for several weeks, may occur during or after sex, and can even last for months or years. It is not often recognized that chronic pelvic pain could be due to a vascular condition. Women need to be aware of this so they can explore what their symptoms are telling them. Here, we’ll discuss what Pelvic Congestion Syndrome is, what it may look like, and what a vascular specialist may do to address pain.

Pelvic Congestion Syndrome is also known as pelvic venous insufficiency. You may know that venous insufficiency, in general, typically refers to varicose veins. From that perspective, we could liken Pelvic Congestion Syndrome to varicose veins in the pelvic region. Pain results from the improper circulation of blood through pelvic veins, causing them to swell. The condition usually affects women between the ages of 20 and 50, most of whom have had at least one birth. It is characterized by pain that lasts longer than 6 months. Sometimes, the pain decreases when lying down or placing the legs up. Pain may increase during menstruation or sexual intercourse. 

Signs and Symptoms of Pelvic Congestion Syndrome

• Location of pain. The condition usually causes pelvic pain as well as lower abdominal pain. Discomfort may feel like pressure or aching and may be constant. 
• Progression of pain. Discomfort from Pelvic Congestion Syndrome usually gets worse with prolonged standing or sitting. Elevating the legs or lying down lessens pain. 
• Painful intercourse. Pain may feel worse during sexual intercourse of after. Discomfort may extend to the lower pain or upper legs.
• Visible varicose veins. Approximately 55% of patients with this condition have vulvar varicosities, varicose veins that can be seen on the vulva, the “lips” outside of the vagina. 
• Iliac venous compression. Visible veins in the gluteal area or on the inner thigh may cause one-sided leg pain and swelling.

Diagnosis and Treatment

A proper diagnosis can take some time due to the fact that doctors typically explore gynecological reasons for pelvic pain before considering vascular causes. A vascular specialist may diagnose Pelvic Congestion Syndrome first by performing a pelvic ultrasound. Additional tests may include MR or CT venogram, which can observe dilated ovarian veins. If diagnostic testing confirms venous insufficiency in the pelvic area, a vascular specialist may perform a stent or embolization procedure to reroute blood flow more efficiently through the area. 

The Vascular Institute of Virginia has offices in Fredericksburg and Woodbridge. For more information about our services for Pelvic Congestion Syndrome, call 703-763-5224.