Pelvic pain worse on standing and after sex (190/1700)

A 45yo waitress complains of pelvic pain which worsens pre-menstrually and on standing and
walking. She also complains of post-coital ache. Select the most likely cause leading to her
symptoms?
a. PID
b. Endometritiosis
c. Pelvic congestion syndrome
d. Adenomyosis
e. Premature ovarian failure

 answerC

Pelvic congestion syndrome is chronic pain exacerbated by standing or sexual intercourse in women who have varicose veins in or near the ovaries.

Pelvic congestion syndrome is a common cause of chronic pelvic pain. Varicose veins and venous insufficiency are common in the ovarian veins but are often asymptomatic. Why some women develop symptoms is unknown.

Symptoms and Signs

Pelvic pain develops after pregnancy. Pain tends to worsen with each subsequent pregnancy.

Typically, the pain is a dull ache, but it may be sharp or throbbing. It is worse at the end of the day (after women have been sitting or standing a long time) and is relieved by lying down. The pain is also worse during or after sexual intercourse. It is often accompanied by low back pain, aches in the legs, and abnormal menstrual bleeding.

Some women occasionally have a clear or watery discharge from the vagina.

Other symptoms may include fatigue, mood swings, headaches, and abdominal bloating.

Pelvic examination detects tender ovaries and cervical motion tenderness.

Diagnosis

·        Clinical criteria

·        Ovarian varicosities, detected during imaging

Diagnosis requires that pain be present for > 6 mo and that ovaries be tender when examined.

Ultrasonography is done but may not show varicosities in women when they are recumbent.

Some experts recommend additional tests (eg, venography, CT, MRI, magnetic resonance venography) if necessary to confirm pelvic varicosities.

If pelvic pain is troublesome and the cause has not been identified, laparoscopy is done.

Treatment

·        Usually NSAIDs

NSAIDs can be tried. If they are ineffective and if the pain is severe, embolization or sclerotherapy may be considered.