Pelvic Pain After Sex or During Sex Could be a Warning Sign of a Vascular Disorder?

Many people experience abdominal pain after sexual activity, a surprisingly common issue that can affect both men and women. Chronic pelvic pain is more common in women; it's important to note that it's not exclusive to them. This pain can vary significantly in intensity, ranging from a mild ache to a severe cramp. The source of the pain can be just as diverse, encompassing gynecological problems, vascular issues, and even muscular strain.

Unlike pain linked to gynecological conditions, which typically resolves within a reasonable timeframe, vascular-related pelvic pain can be a persistent and debilitating issue. Vascular pelvic pain often lasts for extended periods, exceeding six months, and can significantly impact a person's quality of life.

Being able to distinguish between gynecological and vascular causes of pelvic pain is crucial for women's health, as well as understanding potential causes allows for a more accurate diagnosis and developing the right treatment plan.

If you’re a woman who has been struggling with chronic pelvic pain, painful periods, and pain after sex and have ruled out other gynecological disorders, you may need to see a vascular specialist.

Is My Pelvic Pain After Sex Caused by Pelvic Congestion Syndrome?

Pelvic congestion syndrome (PCS) is a vascular condition that primarily affects women and is characterized by chronic pelvic pain. This syndrome may be due to dysfunctional veins in the pelvic region, leading to pelvic venous insufficiency and painful symptoms. Symptoms of PCS often include:

Chronic Pelvic Pain: Patients with pelvic congestion syndrome often experience dull, achy, or pressure-like pain in the lower abdomen and pelvic region lasting more than six months. The pain may be constant or come and go but typically worsens throughout the day. Sitting or standing for extended periods often aggravates symptoms, while lying down and elevating the legs can provide relief.

Pain During and After Sexual Activity: Pelvic pain can worsen during or after sexual intercourse (dyspareunia) and menstruation.

Pain and Discomfort During the Day: Lower back pain and achiness/leg pain may also be present in patients with pelvic congestion syndrome. This lower abdominal pain caused by pelvic congestion syndrome is often relieved by lying down or resting.

Visible Varicose Veins: Up to 55% of patients with pelvic congestion syndrome experience vulvar varicosities visible varicose veins in the vulva, groin, and surrounding pelvic area. Varicose veins in the pelvic and lower leg region can cause pain, swelling, and discomfort, especially with prolonged sitting or standing.

Menstrual Irregularities: Patients with pelvic congestion syndrome may experience severe and painful menstrual cramping (Dysmenorrhea) as well as heavy menstrual bleeding (Menorrhagia).

Lower Extremity Pain: Pelvic congestion syndrome can also cause backaches, leg pain, abdominal bloating, and an uncomfortable feeling of heaviness or “fullness” in the pelvic region and lower abdomen.

It’s essential to consult with a vascular specialist if you are experiencing any of these symptoms, particularly the combination of chronic pelvic pain, pain during sex, and varicose veins in the pelvic area. Early diagnosis and treatment of PCS can significantly improve quality of life and alleviate these often debilitating symptoms.

Why Haven’t I Heard of Pelvic Congestion Syndrome? 

Unfortunately, pelvic congestion syndrome is often underdiagnosed or mistaken for premenstrual symptoms, ovarian cysts, uterine fibroids, or other gynecological issues. Because the symptoms of pelvic congestion syndrome are so similar to other gynecological diagnoses, it’s essential to work with your primary care provider or gynecologist to rule out any other underlying causes of your pelvic pain before seeing a vascular specialist. Gynecologists often exhaust their diagnosis and treatment options when working with patients who suffer from pelvic congestion syndrome. OB/Gyns don’t treat vascular disorders, so it’s not surprising that they may not have mentioned pelvic congestion syndrome. When a diagnosis can't be found for chronic pelvic pain, OB/GYNs often refer patients for mental health support. It can be disheartening to undergo a high volume of testing and not have answers, so it's okay to proactively ask your gynecologist about vascular pelvic disorders and a referral to a vascular specialist.

Several non-vascular reasons can contribute to abdominal pain during and after sexual activity, including:

  • Irritable Bowel Syndrome (IBS)
  • Chronic constipation
  • Food intolerances
  • Urinary tract infections (UTI)
  • Bladder infections
  • Muscle strains or weakness
  • Abdominal hernias
  • Anxiety
  • Tension
  • Vaginal dryness
  • Sexual positions
  • Sexually transmitted infections
  • Uterine fibroids
  • Ovarian cysts
  • Endometriosis
  • Polycystic Ovarian Syndrome (PCOS)

Because pelvic congestion syndrome is often misdiagnosed or mistaken for other gynecological issues, it is essential to consult your primary care provider or gynecologist first. The pain caused by pelvic congestion syndrome is different from typical gynecological pain. It is persistent, lasting over six months, and worsens with prolonged sitting or standing.

Your gynecologist or primary care provider can rule out other common causes of abdominal pain after sex before referring you to a vascular specialist for further evaluation of pelvic congestion syndrome. Remember, various non-vascular factors can also contribute to abdominal discomfort during sex, and a comprehensive diagnosis by a qualified healthcare professional is critical to identifying the root cause of your pelvic pain and finding the most effective treatment plan for lasting relief.

If you experience persistent pelvic or abdominal pain, primarily related to menstrual cycles or after sexual activity, it's crucial to consult with a healthcare provider. Initially, it’s advisable to see a gynecologist to rule out common gynecological causes such as uterine fibroids, ovarian cysts, or pelvic inflammatory disease. If these are excluded and symptoms persist, a consultation with a vascular specialist might be necessary to explore the possibility of pelvic congestion syndrome.

When discussing the possibility of Pelvic congestion syndrome with your OB/GYN, it is essential to gather as much information as possible to understand your condition, its impact on your health, and the available treatment options, especially if your pelvic pain after or during sex isn’t resolving with typical treatments.

Here are some essential questions to consider asking:

  • Have we considered the possibility of pelvic congestion syndrome?
  • My symptoms haven’t improved, and we’ve ruled out other gynecological conditions. Is it time for me to see a vascular specialist?

Sometimes, managing PCS may require a multidisciplinary approach. Ask if a referral to a vascular specialist or a pain management expert is advisable, especially if your OB/GYN has ruled out underlying muscular or gynecological conditions.

The above questions will help you thoroughly converse with your OB/GYN about possible pelvic congestion syndrome causing your symptoms. This conversation with your provider will help you understand your diagnosis, treatment options, how to manage your condition effectively and help you prepare to see a vascular specialist.

You should ask your doctor to explain how PCS could be causing your specific symptoms and what signs typically indicate the condition. You should also inquire about the success rates of the treatments you discuss and the long-term outcomes with your OB/GYN, especially if you’re seeing a vascular specialist for treatment. Your medical team must have the same information to coordinate your care appropriately. 

Diagnosis and Treatment of Pelvic Congestion Syndrome

Diagnosing PCS typically involves a pelvic ultrasound or more definitive tests such as a venogram, where dye is injected into the pelvic veins to make them visible during X-ray examinations. Treatment varies based on the severity of your symptoms but may include:

Medication: Pain relievers and hormonal treatments may help some patients manage symptoms of pelvic congestion syndrome.

Lifestyle adjustments: Weight management, exercise, and avoiding prolonged standing can alleviate uncomfortable symptoms of pelvic congestion syndrome.

Compression stockings: Patients with pelvic congestion syndrome may also struggle with varicose veins in the legs. Compression stockings can help alleviate some lower extremity discomfort. Talk to your vascular specialist about compression stockings and the appropriate way to use them, as patients with peripheral artery disease (PAD) should only wear compression stockings with the direction of a medical provider.

According to vascular specialists, 80% of pelvic congestion syndrome cases can be resolved by inserting a venous stent. If the patient's symptoms continue, a chemical or coil embolization of dilated pelvic varicose veins can be performed by injecting a sclerosing agent directly into the dilated vein or coiling the incompetent veins.

Your Center for Vascular Medicine vascular specialist will work with you to determine the best treatment for your pelvic congestion syndrome. Understanding the underlying causes of your pelvic pain during and after sex can help your medical team identify risk factors or triggers relevant to your condition.

Ask your vascular specialist about your treatment options for pelvic congestion syndrome, including:

  • What causes pelvic congestion syndrome?
  • What treatment options are available for pelvic congestion syndrome?
  • What are the benefits and risks of each treatment option?
  • How effective are these treatments in relieving the symptoms of PCS?
  • Are there lifestyle changes I can make to help manage my symptoms?
  • What should I do if my symptoms worsen or do not improve with treatment?

Discuss all potential treatments, from medications and lifestyle changes to more invasive procedures like embolization or surgery. Ask your vascular specialist about dietary adjustments, exercise routines, or other lifestyle modifications that could help improve your symptoms.

Pelvic Vascular Care at Center for Vascular Medicine

Abdominal pain that occurs after sexual activity is a common problem, but it is essential not to overlook it, especially if it persists or significantly impacts your quality of life. It is crucial to distinguish between gynecological and vascular causes of pelvic pain to ensure that treatment and management are effective. Individuals can achieve better health outcomes and overall well-being by discussing these concerns with healthcare providers, especially vascular specialists.

At Center for Vascular Medicine, our expert vascular specialist will work with you to appropriately diagnose and treat your pelvic congestion syndrome, helping eliminate symptoms and improve your quality of life.

Contact us today to schedule a consultation and take the first step toward understanding and addressing your pain. We serve patients from Annapolis, MD, Columbia, MD, Easton, MD, Glen Burnie, MD, Greenbelt, MD, Prince Frederick, MD, Silver Spring, MD, Waldorf, MD, Fairfax, VA, Fredericksburg, VA, New Brunswick, NJ, and Union, NJ.

Other Resources

Top Warning Signs You Should See a Vascular Doctor

Is Chronic Pelvic Pain a Warning Sign of a Vascular Disorder?

Are You a Woman Suffering from Chronic Pelvic Pain?

Below is a video of a patient who was suffering from Pelvic Congestion Syndrome and how she felt after being treated by Dr. Zoe Deol (right) using a venogram procedure and placing a venous stent

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