Pelvic congestion syndrome is a reported cause of chronic pelvic pain, which is also associated with dyspareunia and vulvar varicosities. Retrograde flow through tortuous and dilated pelvic veins that develop secondary to incompetent valves or obstruction in the ovarian vein is considered the most likely cause. It is estimated that up to 60% of patients with pelvic varicosities are symptomatic. Imaging techniques demonstrate multiple dilated veins surrounding the pelvic organs. Direct connection to the arcuate veins in the myometrium, low velocity flow, and increase in diameter after the Valsalva maneuver all are associated with symptoms. The treatment of pelvic congestion syndrome remains controversial, but bilateral transcatheter embolization with sclerotherapy is reported to successfully improve symptoms in most cases.

Pelvic congestion; pelvic pain; nutcracker syndrome; pelvic vein reflux; pelvic embolization