Primary Symptoms of Pelvic Congestion Syndrome
Pelvic congestion syndrome presents with chronic, noncyclical pelvic pain lasting more than 6 months that characteristically worsens with prolonged standing, coitus, menstruation, and pregnancy, often accompanied by perineal and vulvar varicose veins. 1, 2, 3
Core Pain Characteristics
The pain pattern is distinctly positional and progressive throughout the day, differentiating it from other pelvic pain syndromes:
- Lower abdominal/pelvic pain that is intermittent or continuous, worsening as the day progresses and with activity 4, 3
- Pain exacerbated by prolonged standing due to increased venous pooling and pressure in incompetent pelvic veins 1, 5, 3
- Postcoital pain that is prolonged and may last hours after intercourse 3
- Lower back and upper thigh pain radiating from the pelvis 3
Important distinction: Unlike pelvic inflammatory disease, the pain in PCS follows a positional pattern and worsens with standing, though it may intensify during menses 6. Unlike endometriosis, the pain is not strictly cyclical with menstruation 6.
Associated Symptoms
Beyond pain, patients commonly report:
- Dyspareunia (painful intercourse) occurring in a substantial proportion of cases 4, 3
- Urinary urgency without infection 4
- Constipation related to pelvic venous congestion 4
Physical Examination Findings
Unusual varicosity patterns are pathognomonic when present:
- Vulvoperineal varicosities 2, 3
- Posterior thigh varicosities 3
- Gluteal varicosities 3
- Ovarian point tenderness on pelvic examination 3
Temporal and Demographic Context
The syndrome typically manifests in premenopausal women in their third to fourth decade of life, usually multiparous 2, 5, 3. Symptoms may improve after menopause due to decreased estrogen-driven vascular effects 1.
Common Pitfall
Asymptomatic women may have pelvic varicosities on imaging, making diagnosis challenging 5, 7. The presence of dilated pelvic veins alone does not confirm PCS—the clinical symptom pattern must correlate with imaging findings. Specifically, symptoms persist when periovarian varicosities measure over 5 mm on ultrasound 4.