Symptoms of Pelvic Congestion Syndrome
The cardinal symptom of pelvic congestion syndrome is chronic pelvic pain, typically described as a dull ache that has been present for at least 6 months, which characteristically worsens with prolonged standing, throughout the day, and after physical activity. 1, 2, 3
Primary Pain Characteristics
The pain in pelvic congestion syndrome has distinct features that help differentiate it from other causes of chronic pelvic pain:
- Chronic pelvic pain is the hallmark symptom, defined as pain present for 6 months or more, typically described as a dull ache without evidence of inflammatory disease 2, 3
- Positional worsening is characteristic—pain intensifies with prolonged standing and worsens throughout the day, improving with lying down 4, 5, 3
- Activity-related exacerbation occurs, with symptoms worsening after a hard day's work or physical activity 6, 3
- Noncyclical pattern distinguishes it from endometriosis, as the pain is not primarily related to the menstrual cycle, though it may worsen during menses 5, 3
Associated Pelvic and Sexual Symptoms
Beyond the primary pain complaint, patients frequently experience a cluster of related symptoms:
- Dyspareunia (painful intercourse) is reported in a significant proportion of patients, with prolonged postcoital discomfort being particularly characteristic 6, 4, 3
- Lower back pain extending to the pelvic region and upper thighs is common 3
- Urinary urgency occurs in some patients as a result of pelvic venous congestion 6, 4
Gastrointestinal Manifestations
- Constipation may be present and can worsen symptoms in some patients 7, 6
- Irritable bowel symptoms are frequently reported as part of the symptom cluster 4
Visible Vascular Signs
Physical examination may reveal characteristic varicose patterns, though these signs are not always present:
- Vulval varicosities extending onto the medial thigh and into the long saphenous territory are suggestive findings 2, 4
- Unusual varicosity patterns including vulvoperineal, posterior thigh, and gluteal varicosities should raise suspicion for pelvic congestion syndrome 3
- Lower limb venous pathology of pelvic origin, particularly affecting the posterior thigh, vulva, and inguinal regions 1, 4
Clinical Examination Findings
- Ovarian point tenderness on deep palpation may be present, though this finding is not universal 2, 3
- Absence of inflammatory signs helps distinguish pelvic congestion syndrome from infectious or inflammatory causes of pelvic pain 2
Important Clinical Context
A critical pitfall is that many premenopausal women have dilated pelvic veins on imaging without symptoms, so the presence of anatomic findings must correlate with the characteristic symptom pattern to establish the diagnosis. 5 The average time to diagnosis is up to 4 years after initial presentation, reflecting the underrecognition of this condition 4. Symptoms may subside after menopause in some women due to decreased estrogen stimulation 1.