Pelvic Congestion Syndrome (PCS)
PCS is related to valvular incompetence in the ovarian veins which leads to venous hypertension and engorgement of the venous drainage of the vagina, uterus and ovaries and their supporting ligaments. This can cause symptoms of heaviness, fullness, pain, pressure in the lower abdominal and pelvic regions, back aches, discomfort in the vulva, vagina, and inner thighs, pain during intercourse (dyspareunia) and uncomfortable menses with prolonged bleeding. There are other causes for these symptoms such as endometriosis, pelvic adhesions from chronic infections (PID, pelvic inflammatory disease) and uterine fibroid tumors. Consultation with a gynecologist is a mandatory first step to pursuing this diagnosis. The presence of varicose veins in the vulva, vagina and inner thighs with or without varicose vein in the legs, history of multiple pregnancies and weight gain of more than 40 pounds with each pregnancy are important clues in establishing this diagnosis. The diagnosis may be suggested by the findings of dilated ovarian or pelvic veins on diagnostic laparoscopy, or CT scan but the best confirmation of the diagnosis is from selective pelvic venography or MRI contrast examination. Once the diagnosis is confirmed treatment with embolization (mechanical or chemical agents) can be used to occlude the refluxing veins and reduce the venous hypertension. The subsequent treatment of the residual external varices in the genital area and upper thighs can then be treated in our office with ultrasound guided foam sclerotherapy or Microphlebectomy procedures.