High pressure and stretching of veins in the pelvis may result in pelvic pain, tenderness, or dyspareunia (pain with intercourse). The pain can be either a dull, aching pain or a sharp, deep pain. This pain often is worse just before menstrual period, with prolonged standing, or with intercourse. Once other pelvic organ pathology such as cysts or abnormal growth of the uterus or ovaries or infection have been ruled out, the syndrome commonly is labeled Pelvic Congestion Syndrome.
Some patients with Pelvic Congestion Syndrome (PCS) have an underlying correctable problem. Some have pelvic (iliac) vein obstruction and others have pelvic varicose veins due to venous blood running in the wrong direction from the upper abdomen toward the pelvis. Ovarian vein blood flow usually goes from the ovary toward the left renal (kidney) vein or toward the inferior vena cava, the large vein in the abdomen carrying blood back to the heart. If the one-way valves in the ovarian vein have failed, blood will flow in a reverse direction (reflux) toward the pelvis. Ovarian vein reflux can cause very high pressures to develop in the veins of the pelvis, sometimes causing pelvic pain, dyspareunia, and varicose veins in the deep pelvis.
A similar process in the male causes reflux of blood down a testicular vein into the scrotum. The high venous pressures in the scrotum result in progressive development of varicose veins in the scrotum and the spermatic cord which connects the testicle to the rest of the body. These scrotal varicose veins are called a varicocele. Some varicoceles cause pain, especially with lifting; others reduce the sperm count and may be responsible for male infertility. Treatment of the varicocele by sealing the testicular vein usually resolves the pain or infertility problem.