[Clinical aspects and complementary tests in pelvic congestive states]

Pelvic congestion syndrome is common to three pathologies: premenstrual syndrome, intermenstrual syndrome and chronic pelvic fibrous congestion syndrome. The two first syndromes are well-known. They are periodical and hormonal treatment is relevant in premenstrual syndrome (all forms of progesterone and provascular treatment). Chronic pelvic congestion syndrome or fibrous congestion is linked with fibrous changes of the subperitoneal cellular tissue after more or less lasting chronic congestion. It is sometimes secondary to low noised and unknown sepsis (Bret and De Brux fibro-sclerous pelviperitonis). It is usually linked with the traumatical rupture of cellular pelvic tissue from obstetrical etiology (Masters and Allen syndrome). In varicocele, uterine plexus and ilio-lumbar ligament, hormonal action has been suggested. Three signs overnite polymorphic clinical study: deep dyspareunia, moving cervix, uterus retroversion. But primitive or secondary congestion is only in fact evoked by coelioscopy even with its limits. When coelioscopy is negative, hysterophlebography will be achieved and will visualize sometimes extremely pelvic plexus vasodilatation. As function of findings lesions, treatment lays down 3 principles: first principle not to abuse with surgery except in case of testing patent ligamentary lesions. Second principle to prescribe a polyvalent general treatment with triade antibiotic, antiinflammatory and phlebotonic drugs. Third principle to be preventive by improving obstetrical exercise as usually this syndrome succeeds to a more or less traumatic delivery.