Pelvic Congestion Syndrome: Causes, Symptoms, and Treatments

Chronic pelvic pain is a common occurrence among people assigned female at birth, affecting an estimated 15% of people of childbearing age in the United States. One of the causes of pelvic pain is pelvic congestion syndrome (PCS). PCS occurs when varicose veins develop around the ovaries. Varicose veins are twisted, enlarged veins that most often appear on the legs because standing and walking cause the blood to engorge the leg veins. Most of the time, varicose veins are completely benign and painless but when they appear on the ovaries, they can cause pain and discomfort. The exact cause is still unknown but pregnancy and estrogen can both play key roles in making the veins structurally unsound. Any type of chronic pain can be disruptive to your life so it is important to learn about the cause of your pain and what your treatment options are. This article will cover the symptoms of pelvic congestion syndrome, how it affects one’s sex life, and the treatment options that exist. 

What are the symptoms of pelvic congestion syndrome?

Dull and achy pelvic pain is the primary symptom of PCS, but it can manifest as a sharp pain as well. The pain can be exacerbated after standing or sitting for a long time, before and during menstruation or sexual activity. Additional symptoms include varicose veins in other places like the pelvis, buttocks, and vulva, an irritable bowel, stress incontinence, and pain with urination.   

How does pelvic congestion syndrome affect one’s sex life?

As mentioned above, pelvic congestion syndrome and the associated pain tends to be exacerbated by sexual intercourse. This not only poses physical obstacles to having sex, especially penetrative sex, but chronic pain can also cause a low libido. That does not mean that you can never achieve a fulfilling sex life though. In addition to the PCS treatment options below, there are ways to have great sex without penetration. You can engage in alternative forms of intimacy, like mutual masturbation, give and/or receive a sensual massage, or cuddle skin-to-skin. There are also ways to try to boost your libido, if you so desire. None of these options provide a permanent solution, but there are treatment options that can make it easier to live with PCS. 

   What are the treatment options for pelvic congestion syndrome?

Diagnosing pelvic congestion syndrome is not easy because the symptoms are easily conflated with other conditions and there is no test that will outright prove that PCS is the culprit. For this reason, doctors will typically run tests to rule out similar conditions, as well as use imaging like ultrasounds. Ultrasounds provide a view of the soft tissue; if more detailed imaging is required, a doctor may opt for an MRI or CT scan. The goal of diagnosis and treatment is to reduce or relieve pelvic pain, but there is unfortunately no known cure for PCS. The treatment you and your doctor pursue will depend on factors such as the severity of your symptoms and your medical history.

Treatment options for PCS may include: 

• Gonadotropin hormone drugs. Gonadotropins are hormones that regulate ovarian function; they are essential for growth, development, and reproduction functions. These drugs can block ovarian function and therefore relieve some pain.  

• Progestin hormone drugs. Similarly to gonadotropins, progestin drugs are hormonal drugs that serve to relieve pain by assisting the regulatory function of your reproductive system. 

• Sclerotherapy or embolization. A sclerotherapy is a typical treatment option for any varicose veins, including pelvic veins, such as is the case for PCS. It involves a needle that injects a solution which causes the damaged vein to scar and eventually fade as blood is rerouted to healthier veins. A similar concept but different execution is gonadal vein embolization is a minimally invasive treatment that involves a small incision for a tube that is used to dispatch a sclerosant that blocks the vein, therefore guiding the blood to healthier vessels, similar to how sclerotherapy works. 

• Oophorectomy or Hysterectomy (to remove your uterus and ovaries). An oophorectomy (removal of the ovaries) and hysterectomy (removal of the uterus) are reserved for the most severe cases of PCS after milder treatments have failed. However, these procedures have been shown to be a very effective treatment for PCS pain in treatment-resistant cases.

The Bottom Line

Pelvic congestion syndrome is a taxing condition that has the potential to significantly impact your quality of life, particularly your sex life. However, with a proper diagnosis and treatment plan, you can find relief. If you suspect you have PCS, you should consult with a healthcare professional to explore your options. Additionally, if you need extra support for your mental health and/or your libido and sex life due to the chronic pain, consider reaching out to a therapist.   

Why Does It Hurt Down There? Here's How to Address Pelvic Pain

The pelvic floor muscles refers to the hammock-like musculature that supports your pelvic organs and therefore they are an essential part of executing bodily functions like ridding of stool and pee, and having sex. Like anything else in your body, they can weaken throughout the normal aging process leading to concerns like incontinence, or general pain and discomfort.

Differences between people assigned female versus male at birth

Everyone has a pelvic floor regardless of their gender or reproductive anatomy. Pelvic floor health has different implications depending on the type of anatomy it’s supporting. For people assigned female at birth (AFAB), the pelvic floor muscles support the uterus, bladder, and bowel, and the anus, vagina, and urethra all pass through this group of muscles. The pelvic floor is strongly involved in pregnancy and this is a common cause of pelvic floor dysfunction. For people assigned male at birth (AMAB), the pelvic floor muscles support the bladder and bowel, and the anus and urethra pass through them. Unfortunately, there is next to no research or information about transgender and intersex people and their pelvic floor health.

Common Pelvic Floor Concerns

Having pelvic muscles that are too weak or too tight can cause concern; the idea is to find a balance. Pelvic floor concerns might be the cause of additional problems but it can also be a symptom of conditions like endometriosis, pelvic inflammatory disease, and menstrual cycle cramping.

If untreated, pelvic floor imbalances can cause:

• Sexual dysfunction

  • Sexual dysfunction conditions relating to pelvic floor health include dyspareunia (AFAB people) and erectile dysfunction (AMAB people).  

• Pelvic pain

  • Pelvic floor dysfunction (PFD) is “the inability to correctly relax and coordinate your pelvic floor muscles to have a bowel movement.” It’s more commonly experienced by people assigned female at birth. Symptoms associated with it in addition to pain (usually exacerbated by sexual intercourse or certain movements) are incontinence, bloating and constipation, and lower back pain. 

• Bladder concerns

• If your pelvic muscles are too weak, you may struggle with a frequent urge to pee or an inability to hold in pee. This is often an aftereffect of pregnancy and giving birth. 

• Bowel problems

• Similar to bladder concerns, weak pelvic muscles sometimes struggle to hold in gas or poop, leading to bowel incontinence. On the other end, you might also experience constipation and straining pain when trying to poop. 

Options for Addressing Pelvic Floor Concerns

• Medication

  • Medication options will differ depending on the root cause of pelvic floor concerns. Hormonal based therapies like GnRH, Progestin, and oral contraceptives may be used to treat pelvic floor concerns associated with reproductive conditions such as endometriosis. For pain, over the counter medications like Tylenol can be used. If an infection is the source of pain, you may be prescribed antibiotics. Before starting any medication, discuss with your doctor to make sure it’s the right route for you and that it won’t cause adverse effects.   

• Relaxation techniques

• If your pelvic floor is too tense, you might want to try relaxation techniques such as diaphragmatic breathing and pelvic girdle stretches. 

• Physical therapy

• If your effort with pelvic floor exercises at home don’t work for you or if you’re just seeking professional guidance, physical therapy is a good option. 

• Pelvic floor exercises

• Kegels are the most well known pelvic floor exercise and they’re a great way to strengthen those muscles. Click through on the link above to get more details on how to properly do pelvic floor exercises.

Pelvic floor health is a buzzy topic on social media these days, especially on TikTok. We would caution you against taking any of that advice prior to speaking with a qualified health professional who knows you personally. If your pelvic floor concerns are causing mental distress, consider seeing a sex therapist. For those located in Illinois, reach out to Embrace Sexual Wellness to see if we’re a good fit for you.