Why Do I Still Suffer With So Much Pelvic Pain & Pain With Sex? I Have Already Had So Many Surgeries & Been On Several Medications.

Some causes of chronic pelvic pain like endometriosis show up at an early age, possibly a few years after onset of menstruation, and continue through childbearing and up to menopause with worsening symptoms as time goes on.  Endometriosis is always cyclical in the beginning, meaning the pain shows up with periods, and the rest of the month there is little or no pain.  As it progresses, causing more scarring to the internal genitalia, the pain may worsen and bring fevers, nausea, and dysparunea (painful sex).  Endometriosis is easily diagnosed.

     

Pelvic pain can also be due to anatomic or pathological abnormalities like ovarian cysts, uterine fibroids, an enlarged uterus, chronic yeast or other infections, interstitial cystitis, diverticulitis or IBS, retroverted uterus and adhesions from previous surgeries or infections.  Of course, there are more that are not mentioned, including pelvic nerve disorders and discomfort related to other pain syndromes.

            

One common cause of pelvic pain is Pelvic Congestion Syndrome, a pelvic pain disorder often overlooked or misdiagnosed as endometriosis.  It is thought to be caused by varicose veins in the pelvis, and just like varicosities in the legs or any part of the body, this interferes with circulation and can block inflow and outflow to the pelvis - creating pain, irregular bleeding and many other problems.  Pelvic Congestion is most commonly seen in women between the ages of 20-45 who have had multiple pregnancies.  

The exact cause of Pelvic Congestion Syndrome is unknown, though it is thought that these changes could contribute:

• Physiological: In pregnancy there is a significant increase in fluid, and weight gain is common. It is believed that this excess fluid and weight gain disrupts the veins and causes them to engorge with blood. Over time, the veins become distended and the condition progresses because the valves have been destroyed.

• Estrogen: It is known that estrogens can weaken the vein walls and during pregnancy the increase in estrogens may play a role in the development of varicose veins, which is a common occurrence. Perhaps that is why men do not develop this syndrome.

• Anatomical: Others believe that there may be some anatomical changes in the anatomy of the veins and other structures in the pelvis that may make them more susceptible to formation of varicose veins.

Pelvic venous congestion syndrome is very similar to the condition of varicose veins seen in the legs. In both cases, the valves in the veins that help blood flow toward the heart are either defective or damaged. The function of the valves is to prevent back flow of blood. When the valves are destroyed, pooling of the blood occurs in the veins. The veins become engorged with blood and get bigger, stretching the vein wall.  The enlarged veins can occur near the uterus, fallopian tubes, vulva and even the vagina. The condition can worsen with weight during pregnancy.

   

Pain of varying severity is the most common complaint. The pain is typically dull and not associated with menstruation.  But it can worsen:

• Just before the onset of the menstrual cycle, like endometriosis

• At the end of the day

• After prolonged standing

• During or just after intercourse

• During later stages of pregnancy

The other commonly associated symptoms can include some of the following, and can add to the discomfort and pain.

• Swollen vulva/vagina

• Varicose veins (vulvar, buttocks, legs)

• Abnormal menstrual bleeding

• Tenderness to touch in lower abdomen

• Pain during intercourse

• Painful menstrual periods

• Backache

• Vaginal discharge

• General lethargy

• Feelings of depression

Ultrasound, CT scan or MRI may be used in the diagnosis.  Early treatment options include pain medication, ovarian suppression and alternative therapies such as acupressure and physical therapy.  The surgical option involves stopping blood flow to the varicose veins using noninvasive techniques such as a procedure called embolization.

Medications (ergotamine) that narrowed the veins were tried and hormones were also prescribed, but neither helps.  Prescription pain medications and antidepressants often used for chronic pain work great.  Many 'natural' or alternative treatments bring a lot of  help and many women turn to physical therapy, transcutaneous electrical nerve stimulation, behavior and psychological counseling, trigger point injections, epidural and spinal nerve blocks and acupuncture.

    

Pelvic Congestion Syndrome is a difficult disorder both in terms of diagnosis and treatment. The vague symptoms and variable intensity of pain do not all respond to one treatment. All types of treatments have been recommended and currently, embolization is the preferred therapy. However, before one embarks on any therapy, read and understand the disorder and talk with a reputable physician or radiologist.