Pelvic pain of venous origin: diagnostic insights from transvaginal ultrasonography

Chronic pelvic pain is a common clinical condition among women and accounts for up to 15% of gynecological consultations. Pelvic pain of venous origin is one of the main gynecological causes of chronic pelvic pain, accounting for 16%-31% of cases. Several imaging modalities can be used to evaluate pelvic venous disorders; among them, ultrasonography is a first-line method because it provides real-time anatomical and functional assessment of the pelvic veins. This article reviews pelvic venous anatomy, etiopathogenic mechanisms, clinical manifestations, and imaging findings associated with pelvic venous disorders. Using illustrative cases, this review emphasizes the role of transvaginal ultrasound in detecting pelvic varices, venous insufficiency, and morphological and functional abnormalities, thereby supporting accurate diagnosis and appropriate management.