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A spermatocele is a fluid containing cyst that develops within the epididymis, the coiled tube located on the back of the testicle. While generally non-painful, spermatoceles can cause discomfort and impact fertility. Traditional treatment options include surgical excision, but sclerotherapy offers a less invasive approach.

A spermatocele forms when there is a blockage in the epididymal ducts, leading to the accumulation of fluid and sperm. These cystic masses are typically benign but can grow in size, causing pain or discomfort. While not directly linked to serious health risks, complications such as infection or rupture may occur. Additionally, spermatoceles may impact fertility by causing obstruction to the normal flow of sperm.¹

Spermatocele Surgical Excision

The primary conventional treatment for spermatoceles involves surgical removal through excision. While effective in eliminating the cyst, surgery comes with inherent risks such as infection, bleeding, and postoperative pain. Moreover, the recovery period may involve restrictions on physical activities, impacting daily life.²

Spermatocele Sclerotherapy

Sclerotherapy is a minimally invasive procedure in treating various cystic conditions, including cysts in the kidney and liver. The procedure involves the injection of a sclerosing agent directly into the cystic mass through a catheter after aspiration of the contents. This causes the cyst to collapse without the need for surgical excision. Sclerotherapy however may require multiple sessions. In larger organs such as the kidney, our specialist leaves a drainage catheter in the cystic cavity that patients go home with. Repeat sclerotherapy treatments are performed through the catheter until the cyst resolves. In the testicle however a catheter is not left in place because of the small organ size. The catheter is removed after each sclerotherapy treatment.

Sclerotherapy offers several potential advantages over surgery. Firstly, it is a less invasive procedure that requires no incisions, reducing the risks associated with open surgery. The recovery time is one day if any, and the procedure is performed in our office. Additionally, sclerotherapy minimizes the risk of complications such as infection and bleeding, commonly associated with surgical interventions.³

Postoperative Pain and Recovery Time

One of the primary advantages of spermatocele sclerotherapy is the reduced postoperative pain compared to surgical excision. Surgery often involves incisions and tissue manipulation, leading to more significant discomfort during the recovery period. Sclerotherapy, being less invasive and suture free, results in fast recovery and minimal post-procedural pain.

Complications

Surgical procedures, particularly in the delicate genital area, carry inherent risks of complications such as infection, bleeding, and scrotal hematoma. Sclerotherapy, being a catheter-based intervention, minimizes the risk of infection and bleeding. Complications associated with sclerotherapy are generally rare but can include local discomfort or swelling at the injection site.

Impact on Fertility

The impact of spermatocele treatment on fertility is a crucial consideration. Surgical excision, while effective in removing the cyst, might pose a risk to the delicate structures of the epididymis, potentially affecting sperm flow. Sclerotherapy, by contrast, aims to collapse the cyst without direct manipulation of surrounding tissues, theoretically minimizing the impact on sperm flow and fertility.⁴

Both sclerotherapy and surgery have been shown to effectively alleviate symptoms associated with spermatoceles. However, the less invasive nature of sclerotherapy might contribute to higher patient satisfaction due to a smoother recovery process and reduced post-procedural discomfort.

A critical aspect often overlooked is the impact of the treatment on the patient's overall quality of life. Sclerotherapy, by virtue of being less traumatic and associated with fewer complications, may contribute positively to the patient's psychological well-being during the recovery phase. The ability to resume regular activities sooner and with less discomfort can enhance the overall experience for individuals undergoing spermatocele treatment.⁵

While both spermatocele sclerotherapy and surgical excision aim to alleviate symptoms and improve the patient's quality of life, the choice between the two should be individualized. Sclerotherapy offers a less invasive alternative with potential advantages in terms of reduced postoperative pain, quicker recovery, and fewer complications.

Our doctor has his own ultrasound guided technique and many years of experience that has allowed many patients to achieve successful outcomes. Contact us today to setup an appointment with our doctor to review your medical records and expected outcomes for your particular spermatocele.

Request an appointment to meet with our embolization specialist who will review your imaging and medical records to determine if you are a good candidate and outcomes you can expect.  Consultations can be via an online video telehealth platform or in person at one of the offices in Los Angeles, Orange County or San Diego, depending on the doctor’s availability.  Why should you choose us? Read here.

1. Paick SH, Park HK, Kim HH, Lee SW, Song SU. A clinical study of spermatoceles. Int J Urol. 1999;6(11):553-557.
2. Schwarzer JU, Nieden S, Sticht G, et al. Complete excision of large spermatoceles as a therapeutic option. World J Mens Health. 2019;37(2):239-244.
3. Flanigan RC, Reda DJ, Wasson JH, Anderson RJ, Abdellatif M, Bruskewitz RC. 5-year outcome of surgical resection and watchful waiting for men with moderately symptomatic benign prostatic hyperplasia: a Department of Veterans Affairs cooperative study. J Urol. 1998;160(1):12-16.
4. Paick SH, Park HK, Kim HH, Lee SW, Song SU. A clinical study of spermatoceles. Int J Urol. 1999;6(11):553-557.
5. Ludemann JP, McAninch JW. Acute testicular disorders. Surg Clin North Am. 1997;77(6):1471-1492.

The above information explains what is involved and the possible risks. It is not meant to be a substitute for informed discussion between you and your doctor, but can act as a starting point for such a discussion.

Frozen shoulder, also known as adhesive capsulitis, is a painful condition characterized by the gradual loss of shoulder movement. Traditional treatments include physical therapy, medications, and in severe cases, surgery. However, a newer and less invasive approach, frozen shoulder embolization, is saving patients from invasive surgery.

Frozen shoulder involves the inflammation and thickening of the shoulder joint capsule, limiting its range of motion. While the exact cause is often unclear, certain risk factors have been identified, including age, gender, and certain medical conditions such as diabetes. The condition progresses through painful stages, impacting daily activities and significantly reducing the affected individual’s quality of life.¹

Physical Therapy and Medications

Common approaches to manage frozen shoulder include physical therapy and anti-inflammatory medications. While these methods can provide relief, they may not fully resolve the condition, particularly in severe cases where adhesions within the joint capsule are substantial.

Surgery – Frozen Shoulder Manipulation Under Anesthesia and Capsular Release

For individuals with persistent symptoms, surgical interventions may be considered. Manipulation under anesthesia involves forcefully breaking the adhesions to restore mobility, while capsular release entails surgically cutting through the thickened capsule. While these procedures can be effective, they come with inherent risks, including postoperative pain, prolonged rehabilitation, and the potential for complications such as nerve injury or infection.²

Principles of Embolization

Embolization is a minimally invasive procedure widely used in various medical fields. In the context of frozen shoulder, embolization involves the injection of agents into blood vessels supplying the joint capsule. This reduces blood flow to the inflamed area, alleviating pain and promoting tissue healing.

Embolization Benefits Over Surgery

Several potential benefits make frozen shoulder embolization an attractive alternative to surgery. Firstly, it is a non-surgical treatment, reducing the risks associated with open surgery. Secondly, the recovery time is one day, and the procedure is performed on an outpatient basis. Patients after embolization go home with just a Band-Aid as opposed to sutures with surgery. Additionally, the risk of postoperative complications, such as infections or nerve injuries, is minimized.³

Postoperative Pain and Recovery Time

One of the primary advantages of frozen shoulder embolization is the reduced postoperative pain and recovery compared to surgical interventions. There are no surgical incisions with embolization as it is performed through a pinhole in the skin. Surgery often involves cutting or manipulating tissues, leading to more significant discomfort during the recovery period. Embolization, being less invasive, results in less post-procedural pain and a fast recovery.⁴

Complications

Surgical procedures, particularly capsular release, carry inherent risks of complications such as infection, nerve injury, and bleeding. Embolization, being a catheter-based intervention, minimizes the risk of infection and nerve damage as there is no cutting and there are no major incisions that could introduce an infection. Complications associated with embolization are generally rare but can include bruising or hematoma at the injection site.

Rehabilitation

Postoperative rehabilitation is a crucial aspect of frozen shoulder management. Surgery often necessitates an extended period of physical therapy to regain range of motion. In contrast, embolization might require a shorter rehabilitation period due to the less traumatic nature of the procedure.

Improvement in Pain and Function

Studies suggest that both embolization and surgery can lead to significant improvements in pain and function for individuals with frozen shoulder. However, embolization, with its less invasive nature, may offer comparable outcomes with potentially higher patient satisfaction due to a smoother recovery process.

Quality of Life Considerations

A crucial aspect often overlooked is the impact of the treatment on the patient’s overall quality of life. Embolization, by virtue of being less traumatic and associated with fewer complications, may contribute positively to the patient’s psychological well-being during the recovery phase.⁵

While both frozen shoulder embolization and surgery aim to alleviate pain and improve shoulder function, the choice between the two should be individualized. Embolization offers a less invasive alternative with potential advantages in terms of reduced postoperative pain, quicker recovery, and fewer complications. Those looking to avoid surgical cutting and potential nerve issues can consider embolization as a safer alternative to surgery. Contact our embolization doctor for a thorough discussions to weigh the benefits and risks of each intervention, considering the specific characteristics of the frozen shoulder and the patient’s overall health.

Request an appointment to meet with our embolization specialist who will review your imaging and medical records to determine if you are a good candidate and outcomes you can expect.  Consultations can be via an online video telehealth platform or in person at one of the offices in Los Angeles, Orange County or San Diego, depending on the doctor’s availability.  Why should you choose us? Read here.

1. Neviaser RJ, Neviaser TJ, Neviaser JS. Adhesive capsulitis of the shoulder. J Am Acad Orthop Surg. 2011;19(9):536-542.
2. Buchbinder R, Green S, Youd JM, Johnston RV, Cumpston M. Arthrographic joint distension with saline and steroid improves function and reduces pain in patients with painful stiff shoulder: results of a randomised, double blind, placebo controlled trial. Ann Rheum Dis. 2004;63(3):302-309.
3. Soares DP, Riva FM, De Campos JR. Arterial embolization of the shoulder for the treatment of adhesive capsulitis: a pilot study. J Vasc Interv Radiol. 2016;27(8):1242-1247.
4. Lorbach O, Anagnostakos K, Scherf C, Seil R, Kohn D, Pape D. Nonoperative management of adhesive capsulitis of the shoulder: oral cortisone application versus intra-articular cortisone injections. J Shoulder Elbow Surg. 2010;19(2):172-179.
5. Omari A, Bunker T. Open surgical release for frozen shoulder: surgical findings and results of the release. J Shoulder Elbow Surg. 2001;10(4):353-357.

The above information explains what is involved and the possible risks. It is not meant to be a substitute for informed discussion between you and your doctor, but can act as a starting point for such a discussion.

Pelvic congestion syndrome (PCS) is a condition characterized by chronic pelvic pain due to the engorgement of pelvic veins. Emerging research suggests a potential link between pelvic congestion and fertility issues. 

Understanding Pelvic Congestion Syndrome:

Pelvic congestion syndrome involves the pooling of blood in the pelvic veins, leading to dilation and engorgement. While it's primarily associated with chronic pelvic pain, recent studies have begun to investigate its impact on fertility. The mechanism is not fully understood, but it's theorized that venous congestion might disrupt normal pelvic anatomy and function.¹

PCS Effects on Ovulatory Function:

Pelvic congestion may interfere with normal ovulatory function. The altered hemodynamics and increased pressure in pelvic veins might disrupt the delicate hormonal balance necessary for regular ovulation. Studies have indicated that women with PCS may experience irregular menstrual cycles, which can contribute to fertility challenges.²

Disruption of Fallopian Tube Function:

Pelvic congestion may affect the fallopian tubes, essential for the transport of eggs from the ovaries to the uterus. Engorged veins might cause mechanical compression or alter the microenvironment, potentially hindering the normal function of the fallopian tubes. This interference could reduce the chances of fertilization and implantation.³

Uterine Blood Flow and Implantation:

The increased pressure in pelvic veins can affect uterine blood flow. Adequate blood supply is crucial for a healthy uterine lining, where a fertilized egg implants and grows. Disturbances in blood flow may compromise the endometrium, impacting implantation and early embryonic development.⁴

Association with Unexplained Infertility:

Pelvic congestion has been observed in some cases of unexplained infertility. When routine fertility assessments yield no conclusive results, investigating the pelvic vasculature, especially in the presence of chronic pelvic pain, may offer insights into potential causes of infertility.⁵

Impact on In Vitro Fertilization (IVF) Outcomes:

Studies have explored the relationship between PCS and outcomes of assisted reproductive technologies. Elevated pelvic vein pressure and compromised blood flow may negatively influence the success of IVF procedures. Addressing pelvic congestion before embarking on fertility treatments like IVF may improve the chances of success.⁶

Conservative Management:

Conservative approaches for managing pelvic congestion syndrome include lifestyle modifications, pain management, and hormonal therapies. While these methods may alleviate symptoms, they might not directly address fertility concerns associated with the condition.

Non-Surgical Pelvic Embolization:

Pelvic vein embolization is an interventional radiological procedure that has shown promise in the management of PCS. This procedure is not performed by a surgeon or an OBGYN. It involves the insertion of a catheter into the affected veins, and under x-ray guidance foam and embolic agents are deployed to block the abnormal blood flow. This minimally invasive procedure aims to alleviate symptoms by eliminating venous congestion.⁷

This outpatient procedure is typically one hour with a one-day downtime. Patients go home with just a Band-Aid. Read more about it here.

Improvement in Fertility After PCS Embolization:

Limited studies suggest that pelvic vein embolization may lead to improvements in fertility outcomes for some women with PCS. By addressing the underlying venous congestion, this procedure might create a more favorable environment for conception and implantation.⁸

Pelvic congestion syndrome, though primarily associated with pelvic pain, may have implications for fertility. The link between PCS and fertility is an area of ongoing research, and the role of embolization in improving fertility outcomes is a promising avenue. Addressing pelvic congestion through embolization offers a minimally invasive approach that may not only alleviate symptoms but also potentially enhance fertility in affected individuals.

If you are experiencing chronic pelvic pain and fertility issues consult our doctor to review your medical records to see if you are a good candidate for the embolization treatment.

Appointments are available via an online video telehealth platform or in person at one of the offices in Los Angeles, Orange County or San Diego, depending on the doctor’s availability. Contact Us Today. Why should you choose us? Read here.

1. Beard RW, Reginald PW, Wadsworth J. Clinical features of women with chronic lower abdominal pain and pelvic congestion. Br J Obstet Gynaecol. 1988;95(2):153-161.
2. Soysal ME, Soysal S, Vicdan K. Ovulatory dysfunction in chronic pelvic pain patients with uterine myoma and myoma pseudocapsule: effect of myomectomy. Am J Obstet Gynecol. 2001;185(3):592-595.
3. Varela C, Acosta AA, Haimovici F, Arechavaleta-Velasco F, Krupitzky H, Gadow EC. Microsurgical anatomy of the utero-ovarian veins: a preliminary study. Fertil Steril. 1993;60(3):452-456.
4. Paulson RJ, Collins MG, Yankov VI. Prognosis for clinical pregnancy and delivery after sonographic demonstration of an intrauterine fluid collection. Fertil Steril. 1996;65(5):1145-1148.
5. Hoppe K, Raabe-Oetker A, Klapdor R. [Pelvic congestion syndrome – a significant cause of chronic pelvic pain in women]. Zentralbl Gynakol. 1998;120(9):485-491. (Article in German)
6. Hobbs JT. The pelvic congestion syndrome. Br J Hosp Med. 1990;43(1):54-58.
7. Chung MH, Huh CY. Pelvic congestion syndrome: diagnostic and treatment role of interventional radiology. J Korean Med Sci. 2003;18(2):255-259.
8. Venbrux AC, Chang AH, Kim HS, Montague BJ, Hebert JB, Arepally A. Pelvic congestion syndrome (pelvic venous incompetence): impact of ovarian and internal iliac vein embolotherapy on menstrual cycle and chronic pelvic pain. J Vasc Interv Radiol. 2002;13(2 Pt 1):171-178.

Contact us today to setup a consultation

The above information explains what is involved and the possible risks. It is not meant to be a substitute for informed discussion between you and your doctor, but can act as a starting point for such a discussion.

Pelvic congestion syndrome is a medical condition characterized by chronic pain in the pelvis (the lowest part of the torso). It is caused by a pooling of blood in the pelvic veins which become dilated and tortuous. These twisted, enlarged, swollen veins are known as varicose veins and can cause debilitating pain.

Pelvic congestion syndrome is suspected when a patient’s chronic pelvic pain cannot be explained by other causes. Meaning, PCS is often a diagnosis of exclusion. The pelvis contains various organs such as the urinary bladder, uterus, cervix, vagina, bowel, and rectum. Pathology in any of these organs can cause pelvic pain. As a result, the list of potential causes of chronic pelvic pain is long and varied, including fibroids, pelvic inflammatory disease, ovarian cysts, bowel diseases, and bladder pathology.

An OB/GYN typically begins evaluation for chronic pelvic pain with a pelvic examination, Pap smear, routine laboratory tests, and imaging.2 Once other pelvic causes of pain have been ruled out, an interventional radiology consultation may be recommended for additional assessment and treatment of pelvic congestion syndrome.

Some of the imaging tests that can help diagnose pelvic congestion syndrome include:²

Pelvic ultrasound: This is generally the first imaging study performed in patients who have chronic pelvic pain. It is a non-invasive, non-radiating imaging test that takes about 30 minutes to complete. Visualization of enlarged, twisted pelvic veins and slow and retrograde (reversed) blood flow in the veins are indicative of pelvic congestion syndrome.

Pelvic CT scan: A CT scan of the pelvis can demonstrate varicose veins in the pelvis in greater detail than an ultrasound. However, a CT scan is associated with radiation exposure.

MR venogram: A magnetic resonance venogram is the gold standard in the diagnosis of pelvic congestion syndrome. It is an outpatient, non-invasive, non-radiating imaging study that can demonstrate varicose veins near the uterus, ovaries, and pelvic wall, thus confirming the diagnosis of pelvic congestion syndrome.

Laparoscopy: This is a surgical diagnostic procedure that allows doctors to look directly at organs in the abdomen and pelvis with the help of a camera that is inserted through small incisions. It is a minimally-invasive procedure that may be advised to rule out other causes of chronic pelvic pain and arrive at a diagnosis of PCS by exclusion.

In the United States, 15 out of every 100 women in the 18-50 years age group have chronic pelvic pain.³ The good news is that effective treatments are available for many of the conditions that cause long-standing pain in the pelvis, including pelvic congestion syndrome.

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.

References:

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

Pelvic congestion is a medical condition that causes chronic pain in the pelvis (the lower part of the abdomen). It occurs due to problems with veins in the pelvic area that stop working properly and become enlarged, like varicose veins in the legs. This leads to pain and a dragging, heavy sensation in the lower abdomen. Pelvic congestion is most common in women of childbearing age, especially those who have given birth to more than one child. Fortunately, there are several treatment options available for pelvic congestion pain.

Home Remedies for Pelvic Congestion Pain

It’s always best to seek a medical opinion for pelvic congestion pain. However, if your symptoms are mild, some of the following lifestyle changes may help relieve your pelvic pain.

Exercise: Regular exercise can help improve blood flow and minimize the pooling of blood in the pelvic area. Walking and swimming are good options. Cycling is not advisable as it can put pressure on the pelvic area.

Diet: Pelvic congestion pain can be made worse by constipation. To prevent it, a high-fiber diet is recommended with plenty of whole grains, fruits, vegetables, and fluids. Limiting caffeine intake and carbonated sodas can also help.

Supplements: Some supplements like bioflavonoids and oligomeric proanthocyanidins (OPCs) are believed to have protective effects on blood vessels. Natural sources of these plant compounds include fruits, grape seeds, and berries.

Conservative Treatment for Pelvic Congestion Pain

If your pelvic congestion pain does not get better with diet and exercise, your doctor can prescribe some medications based on your most bothersome symptoms. Some of the pharmaceutical treatment options for pelvic congestion include:³

NSAIDs: Non-steroidal anti-inflammatory drugs are widely available medicines that are used to relieve pain. They may help with pelvic congestion pain. However, this is a symptomatic treatment and does not treat the cause of the pain.

Hormones: Medroxyprogesterone acetate (MPA), danazol, and goserelin are hormonal treatments that can reduce pelvic congestion pain. However, again, they do not treat the underlying cause of the pain and you need to take the medications indefinitely for pain relief.^4,5,6

Definitive Treatment for Pelvic Congestion Pain

Ovarian vein embolization: This is the gold standard for the treatment of pelvic congestion syndrome. It is an outpatient, non-surgical procedure that is performed under moderate sedation. It involves inserting a catheter (thin tube) through a vein in the neck or groin under ultrasound guidance. The catheter is guided to the abnormal veins in the pelvis and they are sealed off. There are no stitches and no hospital stay. Patients typically go home the same day with a Band-Aid. Up to 85% of patients who undergo ovarian vein embolization report a significant reduction in pelvic pain.³ 

Hysterectomy: Surgical removal of the uterus and ovaries is sometimes offered as a treatment for pelvic congestion pain. However, it is not the ideal treatment as some enlarged veins may be left behind on the pelvic walls. Roughly one-third of patients report residual pain after hysterectomy.³ Moreover, ovarian vein embolization becomes difficult or impossible following a hysterectomy.

 Laparoscopic or open surgery: Laparoscopic (minimally-invasive) or open surgery can be performed to tie-up the abnormal veins. However, this is a more invasive procedure compared to ovarian vein embolization. Also, repeat surgery may sometimes be necessary if some abnormal veins are left behind.

Pelvic congestion pain is a debilitating condition that can affect your quality of life. If you suffer from pelvic pain due to congestion, talk to your OB/GYN about your treatment options, including ovarian vein embolization.

Why California Vascular & Interventional?

At CVI, we provide devoted and specialized care for embolization. All clinical decisions are centered on the patient because CVI is owned and controlled by our physician, who is an embolization expert. The doctor has the freedom to spend as much time as needed for patient consultations and medical procedures. Clinical decisions are made based on what is best for you and your treatment, and not influenced by the interests of a profit-driven hedge fund company. The staff are highly trained and dedicated to the patient experience. This allows us to provide the best care and experience for our patients.

Women continue to be thrilled with the totality of their care experience facilitated by our patient-centered approach. Read more about our practice here.

Patient Centered. Dedicated. Comprehensive.

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.

Pelvic congestion syndrome (PCS) is a common cause of pelvic pain that persists for 6 months or longer. Roughly 30-40% of women with long-lasting pelvic pain have pelvic congestion syndrome.¹ PCS occurs due to the presence of dilated (swollen) and twisted veins called varicose veins in the pelvis (lower part of the torso). These enlarged veins are similar to those commonly seen on the legs. Sometimes, hormonal factors and other medical conditions can contribute to the development of enlarged veins in the pelvis and resultant pelvic pain.

If you suffer from pelvic pain, pelvic congestion syndrome can potentially be the culprit. Read on to learn more about the risk factors and symptoms of pelvic congestion syndrome.

Symptoms of Pelvic Congestion Syndrome

Most patients with pelvic congestion syndrome have non-cyclical chronic pelvic pain, i.e., the pain is present throughout the menstrual cycle and it persists for 6 months or more.

PCS pain is often described as dull and aching, but it can also be sharp and throbbing. The pain is generally worse at the end of the day after sitting or standing for prolonged periods and is relieved by lying down. Oftentimes, pain due to pelvic congestion is worse before the onset of menses and during or after intercourse.²

Patients with pelvic congestion syndrome may also experience generalized lethargy (tiredness), dysmenorrhea (painful periods), urinary urgency and frequency, discomfort in the rectum, lower back pain, and swelling and discomfort in the vulva.² Some patients with PCS may have visibly swollen veins on the buttocks, inner thighs, and lower extremities. Many patients with pelvic congestion syndrome have hemorrhoids.

Pelvic pain associated with pelvic congestion syndrome often develops during or after pregnancy and becomes worse with each subsequent pregnancy.

If your symptoms sound similar to the ones described above, talk to your doctor about pelvic congestion syndrome as a possible cause.

Risk Factors for Pelvic Congestion Syndrome

A well-known risk factor for pelvic congestion syndrome is multiple pregnancies. During pregnancy, the capacity of the pelvic veins can increase up to 60-times, leading to stretching and weakening of the veins and damage to the venous valves (venous valves prevent backflow of blood in the veins).³ As a result, the veins become dilated (enlarged) and there is a retrograde (reverse) flow of blood. The accumulation of blood in the pelvic veins leads to varicosities (enlarged veins) and pelvic pain. These changes can persist after the completion of the pregnancy. More than 85% of women with pelvic congestion syndrome have given birth before.¹ Each subsequent pregnancy causes further damage to the veins, which is why the condition is common in women who have given birth multiple times.

There are other less common causes of pelvic congestion syndrome and pelvic pain. In some patients, primary venous insufficiency leads to the accumulation of blood in the veins. This occurs when there is a congenital absence or incompetence of the venous valves, meaning the valves are defective from birth. Rarely, external compression of the pelvic veins can obstruct the outflow of blood, for example, in patients with tumors, nutcracker phenomenon, or May-Thurner syndrome, leading to pelvic pain. The female hormone estrogen causes dilatation (widening) of the pelvic veins and may be associated with pelvic congestion syndrome.⁴

If you suffer from persistent pelvic pain and some of the other symptoms listed above, and especially if you have a history of multiple childbirths, you may have pelvic congestion syndrome. PCS is a treatable condition with safe and effective treatment options. Your doctor can complete a clinical evaluation and order imaging studies to make a diagnosis and advise appropriate treatment for pelvic congestion syndrome.

Why California Vascular & Interventional?

At CVI, we provide devoted and specialized care for embolization. All clinical decisions are centered on the patient because CVI is owned and controlled by our physician, who is an embolization expert. The doctor has the freedom to spend as much time as needed for patient consultations and medical procedures. Clinical decisions are made based on what is best for you and your treatment, and not influenced by the interests of a profit-driven hedge fund company. The staff are highly trained and dedicated to the patient experience. This allows us to provide the best care and experience for our patients.

Women continue to be thrilled with the totality of their care experience facilitated by our patient-centered approach. Read more about our practice here.

Patient Centered. Dedicated. Comprehensive.

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.

Pelvic congestion syndrome is a medical condition characterized by chronic pain in the pelvis (the lowest part of the torso). It is caused by a pooling of blood in the pelvic veins which become dilated and tortuous. These twisted, enlarged, swollen veins are known as varicose veins and can cause debilitating pain.

Pelvic congestion syndrome (PCS) is one of the most common causes of chronic pelvic pain (chronic pain is defined as pain that lasts for greater than 6 months). PCS frequently occurs in young women of childbearing age, especially women who have had 2-3 pregnancies and childbirths. The reason being the increased size of the womb during pregnancy compresses the ovarian veins and potentially damages the valves in these veins, leading to abnormal backward flow of blood. The resultant build-up of pressure causes varicose veins in the vulva, vagina, inner thighs, buttocks, and sometimes down the legs.

Fortunately, there are effective treatments available for pelvic congestion syndrome. However, PCS is frequently overlooked and under-diagnosed, resulting in inadequate treatment.¹ In this article, we describe some of the imaging modalities that are used for the diagnosis of pelvic congestion syndrome.

When is pelvic congestion syndrome suspected?

Pelvic congestion syndrome is suspected when a patient’s chronic pelvic pain cannot be explained by other causes. Meaning, PCS is often a diagnosis of exclusion. The pelvis contains various organs such as the urinary bladder, uterus, cervix, vagina, bowel, and rectum. Pathology in any of these organs can cause pelvic pain. As a result, the list of potential causes of chronic pelvic pain is long and varied, including fibroids, pelvic inflammatory disease, ovarian cysts, bowel diseases, and bladder pathology.

An OB/GYN typically begins evaluation for chronic pelvic pain with a pelvic examination, Pap smear, routine laboratory tests, and imaging.² Once other pelvic causes of pain have been ruled out, an interventional radiology consultation may be recommended for additional assessment and treatment of pelvic congestion syndrome.

How is pelvic congestion syndrome diagnosed?

Some of the imaging tests that can help diagnose pelvic congestion syndrome include:²

Pelvic ultrasound: This is generally the first imaging study performed in patients who have chronic pelvic pain. It is a non-invasive, non-radiating imaging test that takes about 30 minutes to complete. Visualization of enlarged, twisted pelvic veins and slow and retrograde (reversed) blood flow in the veins are indicative of pelvic congestion syndrome.

Pelvic CT scan: A CT scan of the pelvis can demonstrate varicose veins in the pelvis in greater detail than an ultrasound. However, a CT scan is associated with radiation exposure.

MR venogram: A magnetic resonance venogram is the gold standard in the diagnosis of pelvic congestion syndrome. It is an outpatient, non-invasive, non-radiating imaging study that can demonstrate varicose veins near the uterus, ovaries, and pelvic wall, thus confirming the diagnosis of pelvic congestion syndrome.

Laparoscopy: This is a surgical diagnostic procedure that allows doctors to look directly at organs in the abdomen and pelvis with the help of a camera that is inserted through small incisions. It is a minimally-invasive procedure that may be advised to rule out other causes of chronic pelvic pain and arrive at a diagnosis of PCS by exclusion.

In the United States, 15 out of every 100 women in the 18-50 years age group have chronic pelvic pain.³ The good news is that effective treatments are available for many of the conditions that cause long-standing pain in the pelvis, including pelvic congestion syndrome.

Why California Vascular & Interventional?

At CVI, we provide devoted and specialized care for embolization. All clinical decisions are centered on the patient because CVI is owned and controlled by our physician, who is an embolization expert. The doctor has the freedom to spend as much time as needed for patient consultations and medical procedures. Clinical decisions are made based on what is best for you and your treatment, and not influenced by the interests of a profit-driven hedge fund company. The staff are highly trained and dedicated to the patient experience. This allows us to provide the best care and experience for our patients.

Women continue to be thrilled with the totality of their care experience facilitated by our patient-centered approach. Read more about our practice here.

Patient Centered. Dedicated. Comprehensive.

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.

Uterine fibroids are non-cancerous, muscular growths that develop in the wall of the uterus (womb). They are often present in young women during childbearing years and can affect nearly 3 out of 4 women.¹ Many uterine fibroids remain undetected because they do not cause any symptoms. However, fibroids can sometimes cause pain and heavy menstrual bleeding.

Uterine fibroids, which are also called leiomyomas, do not increase the risk of cancer. But when a woman of childbearing age is diagnosed with one or more fibroids in her uterus, fertility and pregnancy-related questions are at the top of her mind. Will the fibroids affect my fertility? Can I deliver a healthy baby? Do my fibroids put me at risk of miscarriage? Will my baby need to be delivered by C-section?

Fibroids are present in up to 10% of infertile women² and are sometimes the cause of the infertility. This does not mean all women with fibroids will be infertile. Fibroids may or may not affect your fertility depending on their size and location.

Large fibroids (more than 6 cm in size) can reduce your chances of becoming pregnant by:²

• Blocking the fallopian tubes (the tubes through which the egg makes its way from the ovaries to the uterus).
• Changing the shape of the cervix (this can influence the entry of sperm into the uterus).
• Compromising the lining of the uterine cavity (this can decrease the chances of the embryo attaching firmly to the uterine wall).

The location of the fibroids can also affect your likelihood of conceiving. Submucosal fibroids (which are present in the inner layer of the uterine wall) can distort the shape of the uterus and interfere with embryo implantation. Other types of fibroids usually have a small or negligible impact on fertility.²

If you have been unsuccessfully trying to get pregnant and your doctors suspect fibroids could be the reason, treating the fibroids can significantly increase your chances of becoming pregnant.²

Two well-known approaches to uterine fibroid treatment include a non-surgical procedure known as uterine fibroid embolization (UFE) and surgical removal of fibroids, which is called myomectomy.

One out of four women with uterine fibroids experiences problems related to fertility.³ In such women, the chances of conception can be increased by treating the fibroids. Uterine fibroid embolization (UFE) is one of the treatment options available to women with fibroids. During the UFE procedure, the blood supply to the fibroids is cut off by placing tiny beads in the uterine arteries. This causes the fibroids to shrink and die.

Studies have shown that UFE can restore fertility in a significant percentage of women with uterine fibroids.³ One study, which enrolled 359 women, found that roughly 40% of the patients become pregnant following UFE, some more than once, for a total of 150 live births in the 2 years following UFE treatment. For 85% of the women, it was their first pregnancy. Nearly 30% of the women conceived spontaneously within one year of the UFE procedure. Almost 80% had resolution of fibroid-related symptoms.³

Other studies have found that women who undergo uterine fibroid embolization have a subsequent fertility rate of 58%, which is marginally superior to the 57% fertility rate achieved with myomectomy (surgical removal of fibroids).⁹ It is worth noting, however, that UFE is a considerably less invasive option compared to myomectomy. Also, myomectomy is not always possible or effective and can result in major complications, including hysterectomy (surgical removal of the uterus).³

In women who undergo UFE, problems during pregnancy and delivery are no more common than in healthy women without fibroids.⁵ However, UFE is sometimes implicated in complications such as miscarriage, low birth weight, and prematurity, although these are extremely rare.⁴

As noted, pregnant women are at risk of complications due to fibroids. The risk of needing a C-section is 6 times higher in women with fibroids.⁶ Uterine fibroids can lead to miscarriage, breech baby, failure of labor to progress, and preterm labor. The risk of pregnancy loss is higher with submucosal and intramural fibroids.² Larger fibroids (more than 3 cm in size) are associated with a higher risk of pregnancy complications.² Women who are contemplating pregnancy can reduce these risks by getting treatment for their fibroids with uterine fibroid embolization.

Contact CVI Fibroid Center today to see if you are a candidate for Uterine Fibroid Embolization (UFE).

Myomectomy is a common treatment for uterine fibroids. It involves surgical removal of the fibroids from the uterus. Myomectomy can be performed in several ways, depending on the number, size, and location of your fibroids.

Some patients with smaller and fewer fibroids may be candidates for laparoscopic (minimally-invasive) myomectomy, but many women require open abdominal surgery.

One of the potential complications of myomectomy is a rupture of the uterus during pregnancy or labor.⁸ Roughly 5% of women who undergo myomectomy suffer this complication. The fear of uterine rupture is the reason for a high rate of cesarean sections in pregnant patients who underwent myomectomy for fibroid treatment.⁸

Uterine fibroid embolization (UFE) is a minimally-invasive, non-surgical treatment for uterine fibroids. It is a safe and effective alternative to surgery and is performed by an interventional radiologist. Some of the benefits of UFE include:

• Treatment is through the blood vessels to the fibroid, which means no cutting or burning the uterus itself.

• UFE is less invasive than myomectomy and leaves no scar.

• Fibroids are up to 30% smaller after UFE.¹⁰

• More than 90% of women experience an improvement in fibroid size-related symptoms one year after UFE.¹¹

• UFE has a lower risk of bleeding and infection compared to a surgical procedure like myomectomy.

• UFE can be performed on an outpatient basis and requires no hospital stay.

• Recovery from UFE is relatively quick and most women can return to regular activities in 1 week.

• The interventional radiologist can treat all your fibroids that need treatment at the same time during UFE. It is not always possible to remove all the fibroids with myomectomy.

If you’ve been diagnosed with uterine fibroids and are concerned about fertility and pregnancy, it’s important to gain at least a basic understanding of your risks and treatment options. Every approach to uterine fibroid treatment has its pros and cons. Ultimately, the treatment you choose will depend on what your doctor recommends and what feels right to you.

To further understand the effects of fibroids on your fertility and pregnancy, seek the expert advice of our  interventional radiologist and your OB/GYN.

Contact CVI Fibroid Center today to see if you are a candidate for Uterine Fibroid Embolization (UFE).

References:

1. Cramer SF, Patel A. The frequency of uterine leiomyomas. Am J Clin Pathol. 1990;94(4):435-438. doi:10.1093/ajcp/94.4.435 https://pubmed.ncbi.nlm.nih.gov/2220671/
2. Guo XC, Segars JH. The impact and management of fibroids for fertility: an evidence-based approach. Obstet Gynecol Clin North Am. 2012;39(4):521-533. doi:10.1016/j.ogc.2012.09.005 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3608270/
3. Uterine Fibroid Embolization Helps Restore Fertility Page 1 of 3 RSNA.org Copyright © 2020 Radiological Society of North America (RSNA) https://press.rsna.org/timssnet/media/pressreleases/14_pr_target.cfm?ID=1951
4. Ludwig PE, Huff TJ, Shanahan MM, Stavas JM. Pregnancy success and outcomes after uterine fibroid embolization: updated review of published literature. Br J Radiol. 2020;93(1105):20190551. doi:10.1259/bjr.20190551 https://pubmed.ncbi.nlm.nih.gov/31573326/
5. McLucas B, Goodwin S, Adler L, Rappaport A, Reed R, Perrella R. Pregnancy following uterine fibroid embolization. Int J Gynaecol Obstet. 2001;74(1):1-7. doi:10.1016/s0020-7292(01)00405-2 https://pubmed.ncbi.nlm.nih.gov/11430934/
6. US Department of Health & Human Services. Office on Women’s Health. Uterine Fibroids. 
7. De Vivo A, Mancuso A, Giacobbe A, et al. Uterine myomas during pregnancy: a longitudinal sonographic study. Ultrasound Obstet Gynecol. 2011;37(3):361-365. doi:10.1002/uog.8826 https://pubmed.ncbi.nlm.nih.gov/20922776/
8. Desai P, Patel P. Fibroids, infertility and laparoscopic myomectomy. J Gynecol Endosc Surg. 2011;2(1):36-42. doi:10.4103/0974-1216.85280 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3304294/
9. SIR: Pregnancy Possible After Fibroid Embolization https://www.medpagetoday.org/meetingcoverage/sir/19034
10. Torre A, Paillusson B, Fain V, Labauge P, Pelage JP, Fauconnier A. Uterine artery embolization for severe symptomatic fibroids: effects on fertility and symptoms. Hum Reprod. 2014;29(3):490-501. doi:10.1093/humrep/det459
11. Spies JB. Current evidence on uterine embolization for fibroids. Semin Intervent Radiol. 2013;30(4):340-346. doi:10.1055/s-0033-1359727