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Association Between Painful Intercourse and Pelvic Congestion

Pain during intercourse, known as dyspareunia, is a distressing condition that affects the quality of life and relationships of many individuals. While there are numerous potential causes of dyspareunia, one lesser-known contributor is pelvic congestion syndrome (PCS).

Pelvic Congestion Syndrome (PCS)

PCS is a condition that occurs when there is chronic, dilated blood flow within the pelvic veins, leading to increased pressure and discomfort in the pelvic region. The exact cause of PCS is not always clear, but several factors may contribute to its development:

  1. Venous Valve Dysfunction: Problems with the valves in the pelvic veins can cause blood to pool and flow backward, resulting in congestion.
  2. Hormonal Changes: Hormonal fluctuations, such as those occurring during pregnancy or with the use of oral contraceptives, can contribute to the development of PCS.
  3. Structural Anomalies: Congenital abnormalities in the pelvic veins or compression of veins by nearby structures can also play a role.

Symptoms of PCS

Pelvic congestion syndrome often presents with a variety of symptoms, including:

  1. Pelvic Pain: A dull, aching, or throbbing pain in the lower abdomen or pelvis, which may worsen during or after sexual intercourse.
  2. Menstrual Irregularities: PCS can lead to heavy or irregular menstrual bleeding.
  3. Varicose Veins: Visible veins on the vulva, buttocks, or thighs may be a sign of PCS.
  4. Lower Back Pain: Some individuals with PCS experience lower back pain that may be exacerbated by prolonged standing or sitting.
  5. Increased Pain with Menstruation: Symptoms may worsen during menstruation.
  6. Pain Improvement When Lying Down: Pain often improves when lying down, as it reduces the pressure on the pelvic veins.

PCS and Painful Intercourse

Painful intercourse, or dyspareunia, is a common symptom of PCS. The mechanisms behind this association include:

  1. Pelvic Congestion: The pooling of blood in the pelvic veins can cause pressure and discomfort in the pelvis, making intercourse painful.
  2. Venous Engorgement: Engorgement of the pelvic veins can lead to increased sensitivity in the pelvic region, making it more prone to discomfort during sexual activity.
  3. Altered Anatomy: PCS can result in anatomical changes in the pelvis, which may affect the positioning of the reproductive organs and contribute to pain during intercourse.

Diagnosis of PCS and Painful Intercourse

Diagnosing PCS and its association with painful intercourse often involves a combination of clinical evaluation and diagnostic imaging. The following diagnostic steps may be taken:

  1. Clinical Assessment: A healthcare provider will conduct a thorough medical history review and physical examination, paying close attention to the patient's symptoms, including painful intercourse.
  2. Imaging Studies: Diagnostic imaging tests, such as ultrasound, CT scans, or magnetic resonance imaging (MRI), may be used to visualize the pelvic veins and assess blood flow patterns.
  3. Venography: In some cases, a venogram, a specialized X-ray procedure using contrast dye, may be performed to directly visualize the pelvic veins and assess blood flow.

Treatment Options for Painful Intercourse Due to PCS

Management of PCS and its associated painful intercourse symptoms typically involves a combination of conservative measures and interventional procedures. Treatment options may include:

  1. Lifestyle Modifications: Healthcare providers often recommend lifestyle changes such as avoiding prolonged standing or sitting, engaging in regular exercise, and using supportive garments like compression stockings to alleviate symptoms.
  2. Pain Medications: Over-the-counter pain medications or nonsteroidal anti-inflammatory drugs (NSAIDs) may be prescribed to manage pelvic pain.
  3. Hormonal Therapy: Hormonal treatments, such as oral contraceptives or hormonal intrauterine devices (IUDs), may be suggested to regulate menstruation and reduce symptoms.
  4. Embolization: Transcatheter arterial embolization is a minimally invasive procedure where an interventional radiologist blocks the abnormal veins responsible for pelvic congestion. This can provide long-term symptom relief for many individuals[^1^].
  5. Surgical Options: In severe cases where other treatments are ineffective, surgical interventions like vein ligation or vein stripping may be considered.
  6. Physical Therapy: Pelvic floor physical therapy, which includes exercises and techniques to strengthen and relax the pelvic floor muscles, may be beneficial in reducing pain during intercourse.

PCS Gold Standard Treatment

Pelvic and ovarian vein embolization is the gold standard and most effective treatment option for PCS. This procedure is outpatient, non-surgical with no downtime. Read more here.

Pelvic congestion syndrome (PCS) is a condition characterized by chronic pelvic pain due to venous congestion in the pelvic region. One of the distressing symptoms associated with PCS is painful intercourse (dyspareunia). Understanding the link between PCS and dyspareunia is crucial for effective diagnosis and management.

Patients experiencing painful intercourse, especially in the presence of other PCS symptoms such as pelvic pain and varicose veins, should seek medical evaluation. Diagnosis typically involves clinical assessment and imaging studies to visualize the pelvic veins and blood flow patterns.

Treatment options for painful intercourse due to PCS range from conservative measures, such as lifestyle modifications and pain medications, to interventions like embolization or surgery. The choice of treatment depends on the severity of symptoms and individual patient factors.

Ultimately, early diagnosis and appropriate management of PCS can lead to significant improvements in the quality of life for individuals experiencing painful intercourse and other associated symptoms.

Contact us today to find out if you are candidate for embolization. You can obtain a consultation virtually via a video telehealth platform or meet our doctor in person at one of our office locations in Los Angeles or Southern California.


  1. Andrews RT, Vasquez JC, Mathews CS, Raabe RD. Pelvic congestion syndrome: early clinical results after transcatheter ovarian vein embolization. Journal of Vascular Surgery. 1994;20(5):726-733. doi:10.1016/s0741-5214(94)70129-4
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