Utilizing a Patient-Centric Diagnostic and Treatment Algorithm for Pelvic Congestion Syndrome (PCS) to Maximize Positive Outcomes and Patient Satisfaction

Abstract

Although presentation can be diverse it is commonly described as noncyclical, dull or aching pelvic pain, typically unilateral, and often accompanied by dysmenorrhea and dyspareunia [1,2]. The underlying pathophysiology of PCS is due to multiple factors but the characteristic pain presentation is thought to be a direct result of varicosities of the pelvis. Valvular insufficiency and venous reflux or obstruction manifesting as ovarian vein or hypogastric vein congestion often result in pelvic varicosities [3]. External varicosities are not present in all cases of PCS; areas that they are commonly seen include the vulvoperineal, posterior thigh and gluteal regions, and occur in venous regions drained by either the ovarian or internal iliac veins. Patients become symptomatic when the distended and tortuous veins are compressed locally, causing subsequent irritation and inflammation of nearby organs in proximity to the engorged and swollen plexus of pelvic veins.