PELVIC PAIN AND PELVIC VENOUS CONGESTION

Many women undergo laparoscopy for the investigation of chronic pelvic pain with negative results. Pelvic venography has facilitated the identification of pelvic venous congestion which is an important cause of otherwise unexplained pelvic pain. The use of ultrasound has indicated a possible causal relationship with ovarian dysfunction. Psychological studies have been limited by methodological problems but have indicated differences which might account for perception of physiological sensation as painful, and have pointed to antecedent factors such as child sexual abuse. Pelvic pain with venous congestion responds well to treatment by ovarian suppression with medroxy-progesterone acetate and the duration of benefit is enhanced by concurrent psychotherapy.