Pelvic Congestion Syndrome: The Gynecological Perspective.

Area of Science:

• Gynecology
• Vascular Medicine
• Pain Management

Background:

• Chronic pelvic pain (CPP) affects over 40% of women globally, with no cause identified in up to half of cases.
• Pelvic congestion syndrome (PCS), or pelvic venous insufficiency (PVI), accounts for up to 30% of CPP but is often underdiagnosed.
• PCS stems from pelvic vein reflux/obstruction, causing dull, aching pain exacerbated by standing and intercourse, predominantly in premenopausal women.

Purpose of the Study:

• To enhance understanding of PCS pathophysiology, diagnosis, and treatment.
• To provide practical guidance for diagnosing and managing PCS in routine gynecologic practice.
• To identify accessible, non-interventional diagnostic tools for primary gynecological care.

Main Methods:

• Comprehensive literature review on PCS clinical presentation, pathophysiology, and diagnostic/treatment modalities.
• Focus on accessible, non-interventional tools for primary gynecological care.
• Analysis of diagnostic performance of various imaging techniques, including laparoscopy and ultrasound.

Main Results:

• PCS shares symptoms with endometriosis (dysmenorrhea, dyspareunia) but has distinct features like post-coital pain and pain worsened by prolonged standing.
• Transvaginal ultrasound (TVUS) is a potent first-line tool for PCS diagnosis, with key criteria including ovarian vein diameter (>7-8 mm), low flow velocity (<3 cm/s), and myometrial vein dilatation (>5 mm).
• Laparoscopy has limited sensitivity for PCS due to CO2 pneumoperitoneum and Trendelenburg positioning, unlike venography.

Conclusions:

• Integrating vascular TVUS into routine CPP workup is crucial for diagnosing both endometriosis and PCS.
• Standardized TVUS protocols and interdisciplinary care involving gynecologists and interventional radiologists are needed.
• Addressing the co-occurrence of endometriosis and PCS requires multimodal approaches, considering their bidirectional pathophysiological influence.