[Chronic varicose pelvic veins]

After a long period of neglect, pelvic vein pathology must be recognized today as a true pathological entity. It is easy to understand how fragile the veins are and how liable to poor venous return when the anatomical, histological and functional characteristics of the venous system of the pelvis are properly understood. Furthermore this pathology has an adverse effect on peripheral and underlying venous functions. Initially revealed by transuterine hysterophlebography, the morphological and functional disorders of the pelvic veins can now be shown by color Doppler ultrasonography, which is indeed the tool of first intention for diagnosis and therapeutic assessment, being capable of displaying the variations in calibre of the veins and more particularly of establishing their flow rates. Study of pelvic vascularization has two fundamental applications for gynecology: non specific chronic, pelvic pain which represents between 15 and 20% of reasons for patients consulting, and premenstrual syndrome dominated by congestive phenomena. The indispensable accompaniment to Doppler ultrasonography for investigation of persistent pelvic pain is laparoscopy, which confirms the venous dilatation involved, assesses any associated lesions also liable to slow venous flow and offers simple and efficient methods for treatment.