Pelvic Congestion Syndrome

Featured in Fayette Woman Magazine

My name is Ellie Emini I am a 34-year-old accounting specialist for the city of Tyrone. I am married, have two wonderful children, and consider myself to be physically fit and very active. My story is that I have had significant spider veins and varicose veins in both of my legs since giving birth to my second child. I originally had a large amount of spider veins on my upper thigh and my legs hurt whenever I was on them for any period of time. I decided to seek vein treatment in 2014 and went to a vein center in the area. I had a consultation and ultrasound. The doctor suggested that I have three vein ablation procedures and then a series of sclerotherapy treatments.

 

After receiving treatment, I still had pain and the veins on my upper and outer thigh looked worse. The veins on the posterior thigh actually turned dark and even more unsightly. Despite the ablations, numerous ultrasounds and multiple sessions of sclerotherapy, the doctor told me there was nothing left that he could do for me. By this time, I regretted getting my veins treated. I felt like I had made a huge mistake, gave up on my legs ever looking good again and figured that I would have to live with pain.  

By chance I ran into Brian Sapp, a vascular sonographer, in the grocery store and he told me that he was working with Dr. Feldman and felt that he could help me. I had another ultrasound test, and Brian found a problem in my pelvis that was causing my leg issues. I also had many symptoms that I never contributed to veins. After years of suffering and numerous ultrasound scans done by other technicians, Brian was able to diagnose me with pelvic congestion syndrome and referred me to someone who specialized in that treatment. I had an MRI and venogram that confirmed the findings that were diagnosed at Truffles. I had one ablation at Truffles on a vein that was previously missed and then pelvic embolization. After a couple weeks, all of the discoloration and spider veins in my posterior thigh disappeared. Literally, you could not see one spider vein on my leg. Dr. Feldman, Brian and their staff are wonderful. I cannot say enough about the level of customer service I received from them. I would definitely recommend Truffles Vein Specialists to anyone suffering from pelvic pain, leg pain, restless leg syndrome, varicose veins, spider veins or if you need a second opinion. Until the diagnosis at Truffles I had suffered for nearly a decade with discomfort and pain that I had no idea was vein-related. 

 

Pelvic Congestion and Iliac Vein Disease is Often Missed.

Pelvic congestion syndrome is commonly missed and oftentimes results in unnecessary procedures and testing. Nearly 25% of women who visit an OB/GYN for pelvic pain have pelvic congestion syndrome. Pelvic congestion is caused by varicose veins in and around the pelvic organs. This is often secondary to compression of the iliac vein in the abdomen. Signs and symptoms include pain during or after intercourse, pain in the legs during menstruation, hip pain, low back pain, irritable bowel symptoms, irritable bladder symptoms, labial veins, hemorrhoids, and vein around the outer thigh, posterior thigh and groin area. Vein disease above the waist is not often diagnosed at most vein centers. Brian Sapp, RVT, RPhS is one of the few vascular technologists in the country who performs this kind of testing and teaches the advanced venous course for Philips Healthcare. Truffles Vein Specialists specializes in the diagnosis of all vein disease including pelvic and iliac vein disease.


Pain during menstruation, painful intercourse and pain in the back of the leg when standing all are symptoms of pelvic congestion syndrome. Some patient have more proximal disease in the iliac veins, ovarian veins and this can be treated.

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.

Facts and Definition of Painful Intercourse

Iliac vein compression or stenosis caused pelvic congestion syndrome

Pain during intercourse (dyspareunia) is pain or discomfort in a woman's labial, vaginal, or pelvic areas during or immediately following sexual intercourse. The word dyspareunia comes from the early Greek language, and its meanings include "badly mated" or "difficulty mating". Pain during intercourse is described in medical literature dating back to the ancient Egyptian scrolls. Today, most causes of dyspareunia can be easily discovered and treated.Many women experience some pain during their first episode of vaginal sexual intercourse. In studies 25% of all women who visit the OB/GYN for pelvic pain during intercourse have what is known as pelvic congestion. This should be easy to diagnose, however typical GYN ultrasounds while looking directly at the varicose veins around the uterus do not document the findings. Also, both doctors and women fail to freely discuss sexual practices.  Recent studies suggest that more than many women report current or previous episodes of pain during sexual relations. Fewer than half of these women discussed this pain with their doctors.

What Are the Symptoms of Painful Intercourse (Sex)?

Symptoms of pain related to sexual intercourse can occur when entry is attempted or during and/or immediately following sexual intercourse.The most common symptom is pain on entry (intromission). The pain may be described as sharp or burning.The second most common symptom is deep pain. Other symptoms include feelings of muscle spasms, pelvic cramping, or muscle tightness. Pain during intercourse may be described as primary or secondary; as complete or situational; and as superficial-entrance or deep thrust types.

Primary pain with intercourse is pain that has existed for the woman's entire sexual lifetime. Secondary pain develops after a symptom-free period of time. Complete pain means the woman experiences pain in all times during intercourse. Situational pain occurs with a particular partner or a certain type of stimulation. Superficial-entrance pain is noticeable at penetration. Deep thrust pain is located at the cervix or in the lower abdominal area and is noticeable during or after penetration. A woman may perceive pain during intercourse even without any physical cause. Many health professionals believe that sexual pain without an apparent physical cause may have a psychological origin, however new technology and advances in venous imaging have identified pelvic congestion as a cause of 25% of dyspareunia. Recent studies suggest that 60% of women who have been treated with psychological issues have pelvic congestion syndrome. When these women are treated they get better!  

Do you have vein disease? Find out now!

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