Abstract / Summary
Chronic pelvic pain is a common and challenging condition with a broad differential diagnosis and a substantial impact on quality of life.Pelvic congestion syndrome (PCS) is a clinical manifestation of pelvic venous disease that may involve venous reflux, obstruction, collateralization, and dilation across different pelvic venous territories.Its non-specific clinical presentation and overlap with gynecological, gastrointestinal, and musculoskeletal disorders may lead to significant diagnostic delay.A 42-year-old woman presented to a general and family medicine consultation with a six-year history of chronic pelvic pain, progressively worsening over the previous six months.She described persistent pressure-like pelvic pain, rated 7/10 in intensity, aggravated by prolonged standing and associated with severe deep dyspareunia, which prevented sexual intercourse, associated with low back pain radiating to the pelvis and both thighs, lower-limb heaviness, and significant sleep disturbance.She denied urinary symptoms or a relationship with the menstrual cycle.During the previous six years, she had undergone repeated medical assessments, with symptoms being attributed to recurrent gynecological infections, probable irritable bowel syndrome, and other non-specific causes.Previous investigations, including colonoscopy and emergency department assessments, had not identified a clear etiology for her symptoms.Physical examination revealed hypogastric tenderness and mild superficial lower-limb varicosities, without vulvar or perineal varices.Pelvic and lumbar computed tomography (CT) demonstrated bilateral dilated periuterine veins measuring up to 13 mm, raising suspicion for a symptomatic pelvic venous disorder.The patient was referred to vascular surgery for further assessment; however, specialist evaluation remained pending at the time of manuscript revision.Pelvic venous disease should be considered in women with persistent pelvic pain, particularly when symptoms worsen with prolonged standing or sexual intercourse and are accompanied by low back pain or lower-limb heaviness.The absence of vulvar varices or previous inconclusive investigations does not exclude a possible pelvic venous etiology.This case illustrates how the non-specific presentation of pelvic venous disease may result in years of fragmented investigation and delayed recognition.Continuity of care in general and family medicine facilitated a longitudinal review of the patient's symptoms and previous investigations, allowing recognition of a pattern suggestive of pelvic venous disease.Greater awareness of pelvic venous disease in primary care may facilitate earlier consideration and appropriate specialist referral in women with otherwise unexplained chronic pelvic pain.