Pelvic Pain After Sex or During Sex...A Warning Sign of a Vascular Disorder
Pelvic pain during or after sex can be a warning sign of a vascular disorder. This a debilitating pain lasting 6 months or more. Women need to be aware and tell the difference between gynecological pelvic pain and pelvic pain of a vascular origin. This article will shed light on chronic pelvic pain of a vascular origin. Most importantly women will discover what is pelvic pain telling you about venous insufficiency in that region, and when to visit a vascular specialist instead of your gynecologist (ObGYN).
Pelvic Venous Insufficiency is also known as Pelvic Congestion Syndrome is often overlooked and underdiagnosed vascular condition. This condition mostly affects young women that often have more than one birth and are between the ages of 20-50 years.
It is characterized as chronic pelvic pain lasting greater than 6 months in duration, which is said as due to large, dilated veins in the pelvic area leading to venous reflux and inadequate drainage of blood. Venous reflux occurs when venous valves don't work properly, leading to improper blood flow through the valves during long periods of standing or sitting. Venous reflux most commonly occurs when vein valves weaken due to genetic influences or multiple pregnancies, among other factors.
This improper drainage of blood causes pooling in the pelvic area causing unnecessary pain and a feeling similar to a "bowling ball stuck between the groin region." The pain subsides with lying down or placing the legs up to help with blood drainage. This also can cause very painful menstruation cycles, pain during sex, OR after sexual intercourse.
The patient may not link their pelvic pain to a vascular issue because there are a lot of gynecological issues to rule out. The physician diagnosing this type of disorder must have a 360-view of all the possible causes of chronic pelvic pain before determining the best treatment option. Patients who link the pelvic pain to vascular problem indicate that they have poor blood circulation in the pelvic or groin region.
Signs and Symptoms
Pain location - Chronic lower abdominal and pelvic pain for more than 6 months described as dull, achy pain or pressure, however may be constant and persistent.
Pain progression - Symptoms worsen as the day progresses and usually worse with prolonged hours of sitting and/or standing, often times relieved by lying down and elevating the legs.
Pain during or after sex - Pelvic pain is sometimes worse during and after sexual intercourse, during and after menstruation, and often accompanied by lower back and achiness/pain in the legs.
Visible varicose veins - Presence of vulvar varicosities in 55% of patients that are associated with pain, swelling, and discomfort of the vulvovaginal area with prolonged sitting and/or standing, most common during pregnancy, however, can persist postpartum.
Iliac venous compression - In the presence of iliac venous compression, varicosities of the inner thigh, the gluteal area with unilateral leg pain and swelling are often reported.
A proper ultrasound, venogram, and IVUS completed by a vascular specialist will solidify that signs and symptoms are valid.
Non-invasive testing is usually the first way to diagnose this disorder including a transabdominal pelvic ultrasound.
CT venogram, MR venogram is also used to evaluate for dilated ovarian veins resulting in retrograde flow secondary to valvular incompetence and the presence of several dilated pelvic venous collaterals resulting in venous reflux. CVM provides CO2 venograms if the patient is allergic to dyes.
Laparoscopy can also rule out other etiologies of chronic pelvic pain including endometriosis and/or masses.
Conventional venography for evaluation of dilation and reflux of ovarian and pelvic venous collaterals with evidence of stagnation of contrast media.
Intravascular ultrasound (IVUS) imaging helps detect areas of iliac venous compression including the diameter and length of the lesion.
Vascular specialists have found that 80% of PCS cases are resolved with only a venous stent. If the patient's symptoms persist a chemical or coil embolization of dilated pelvic varicosities is done by injecting a sclerosing agent directly into the dilated vein and/or coiling the incompetent veins. This is known as embolization of the vein.
Dr. Peter Pappas the leading physician of this disorder explains the procedure in this video.
What to expect from CVM
At the Center for Vascular Medicine, our mission is to help patients with their vascular diseases in a cost-effective and compassionate manner. We specialize in the diagnosis and treatment of venous and arterial diseases in the legs, feet, and pelvis. Our world-class providers are the most experienced in the specialty and work with patients to develop a treatment plan that is custom-tailored to their unique situation.
However, Ultrasound alone cannot confirm a diagnosis. The gold standard of diagnosis in our field includes venogram procedure, and intravascular ultrasound (IVUS). These imaging modalities are minimally-invasive so we always opt to begin with ultrasound before recommending further evaluation. No hospital stays are required and the patient can go back to work the next day. If you are recommended a procedure, our provider team will go through all of your options in detail and provide all the information you need to be prepared and to make an informed decision.
The Center for Vascular Medicine provides multiple follow-up visits to answer questions and check for any complications post-procedure. These visits can include Telehealth or in-person visit. Book an appointment if you are experiencing the above symptoms.