Clinical aspects of pelvic congestion syndrome

The main symptom of pelvic congestion syndrome (PCS) is pelvic pain. Women typically have a dull, throbbing, and achy pain in the vulvar region, which often worsens during or after intercourse, just before the onset of menstruation, and as the day progresses, especially in women who stand or sit for long periods. The cause of PCS is unknown; however, multiple factors, such as venous reflux, venous obstruction, and hormones, are most likely involved. Pelvic pain and refluxing pelvic veins are often present in premenopausal women; however, their presence does not always establish a cause and effect relationship. In patients who have clinical symptoms, signs, and imaging findings compatible with PCS, the diagnosis can be made only after other causes of abdominal and pelvic pain have been excluded. The patient history should include the nature, intensity, pattern, location, duration, and radiation of the pain, as well as any exacerbating and relieving factors. PCS is more often diagnosed in multiparous women younger than 45 years old, possibly because the ovarian veins increase in size during each pregnancy and do not return to normal in women with PCS. The differential diagnoses for pelvic pain are vast, further adding to the complexity of the disorder.