Pudendal Nerve Irritation as Unique Symptom of Pelvic Congestion Syndrome

Pelvic congestion syndrome (PCS) is an underdiagnosed but not rare cause of chronic pelvic pain, affecting approximately 10%-30% of women of reproductive age. It is characterized by venous insufficiency and dilation of the ovarian and pelvic veins, often presenting with symptoms that worsen during menstruation or prolonged standing, and improve in the supine position. Dyspareunia and a sensation of pelvic heaviness are also frequently reported. Neurological manifestations-such as pudendal or femoral nerve irritation-are rare but may offer key diagnostic clues. We present a case of a 30-year-old woman with right-sided pelvic pain radiating to the groin and proximal thigh, consistent with neural irritation. Magnetic neurography revealed dilated pelvic veins in close proximity to the right psoas muscle and the L5 nerve root, suggesting perineural venous engorgement. Selective venography confirmed bilateral ovarian vein insufficiency, and the patient underwent successful embolization with Ruby coils and adjunct sclerotherapy. Postoperative recovery was uneventful, with complete resolution of symptoms. Follow-up at 1 year showed no recurrence, and the patient later achieved a successful pregnancy. This case highlights the potential for pelvic venous congestion to mimic or cause neural symptoms and emphasizes the diagnostic value of magnetic neurography in complex pain presentations. Endovascular treatment proved safe and effective, even in cases with neurological involvement.