🤔“All your tests are normal.”

But the pain is real.

Some women walk into the clinic carrying months… sometimes years… of pelvic pain,

after being told again and again: “Nothing is wrong.”

😥But something is wrong.

It might be Pelvic Congestion Syndrome (PCS) 

a condition that is often missed, simply because we are not looking for it.

🔍 What is PCS?

It’s not a mass.

Not a cyst.

Not endometriosis.

It’s a venous disorder where pelvic veins become dilated and incompetent, leading to congestion and chronic pain.

Think of it as varicose veins… but deep inside the pelvis.

⚠️ When should we suspect it?

Chronic dull pelvic pain (>6 months)

Worse after long standing

Worse before menstruation

Worse after intercourse (postcoital ache  a key clue)

Worse at the end of the day

Better when lying down

Associated symptoms may include:

Dyspareunia

Lower back heaviness

A feeling of pelvic pressure or fullness

Sometimes visible vulvar or perineal varicosities

🧠 Why it’s often missed Because:

It does not appear as a “typical gynecological lesion”

Early imaging can be misleading

It requires clinical suspicion, not just investigations

And most importantly…

👉 we are trained to look for masses, not veins.

🔎 How do we diagnose it properly?

Transvaginal Doppler ultrasound (looking specifically for dilated veins)

MRI / MR venography

Venography (gold standard — and can be therapeutic)

💊 What about medications like Venex or Vensomin? 

These are venoactive agents that may:

Improve venous tone

Reduce congestion-related discomfort

👉 They can help symptoms in mild cases

❌ But they do NOT treat the underlying venous reflux.

💉 So what actually works? 👉 Ovarian vein embolization (± internal iliac branches).

A minimally invasive procedure performed by interventional radiology,

targeting the source of venous reflux.

📊 Many patients experience significant symptom relief.

❗ Important clinical clarification Some

 patients report pain after

Current evidence shows:

It is not a proven cause of PCS

But it may unmask a pre-existing condition

💬 Why this matters Because labeling these women as:

“Normal”

“Hormonal”

Or “psychological”

…only delays the right diagnosis.

💡 Take-home message 

Not every pelvic pain is endometriosis.

Not every normal scan means nothing is wrong.

Sometimes…

the problem is not what we see.

It’s what we don’t think about.

#DrRababCares

#PelvicPain 

#WomensHealt 

#ChronicPain 

#MedicalAwareness