104 Romanian medical JouRnal – Volume lXViii, Supplement 6, 2021 Corresponding author: Bianca-Margareta Mihai E-mail: bmmihai@gmail.com Ref: Ro Med J. 2021;68(Suppl6) DOI: 10.37897/RMJ.2021.S6.16 Article History: Received: 27 November 2021 Accepted: 22 December 2021 Pelvic congestion syndrome – case report Roxana Elena Bohiltea 1,2 , Bianca-Margareta Mihai 2 , Bogdan Dorobat 3 , Ionita Ducu 4 , Tiberiu Augustin Georgescu 5,6 , Nicolae Bacalbasa 1 , Corina Grigoriu 1,4 1 Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania 2 Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, Bucharest, Romania 3 Department of Interventional Radiology, Emergency University Hospital, Bucharest, Romania 4 Department of Obstetrics and Gynecology, Emergency University Hospital, Bucharest, Romania 5 Department of Pathology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania 6 “Alessandrescu-Rusescu” National Institute for Mother and Child Health, Bucharest, Romania ABSTRACT Pelvic congestion syndrome is unfortunately an often-misdiagnosed disorder that causes chronic pelvic pain in women of fertile age. The main symptoms are represented by chronic pelvic discomfort or pain. This pathology appears to be relat- ed to a venous disorder generating pelvic varicosities. There are no standardized diagnosis criteria or treatment guide- lines to aid in the management of pelvic congestion syndrome. The therapeutic options consist in medical or surgical treatment, sclerotherapy and endovascular treatment. We present the case of a 33-year-old woman with a severe case of pelvic congestion syndrome, that has affected her both physically and emotionally. The patient received specialized treatment in a Spanish medical unit, with subsequent improved symptoms. We concluded that should be founded spe- cialised centres in our country for the diagnosis and treatment of pelvic congestion syndrome so that these young pa- tients could embrace a normal, painless life. Keywords: pelvic congestion syndrome, pelvic pain, embolization, ultrasound INTRODUCTION Pelvic congestion syndrome (PCS) represents a poorly understood pathology (1), consisting in chronic pelvic discomfort and pain aggravated by prolonged standing or sexual intercourse, affecting women of childbearing age who present periovari- an varicosities during ultrasound examination (2). The true incidence cannot be reported due to the absence of diagnostic criteria, but pelvic congestion syndrome accounts for up to 30% of cases present- ing chronic pelvic pain (3). The etiopathology ap- pears to be related to a primary venous pathology as women suffering from PCS have dilated, incom- petent or with reflux ovarian veins (3,4). Risk fac- tors associated with PCS are multiparity, probably due to the 50% increase in the pelvic venous capac- ity during pregnancy with reflux and venous in- competence afterwards (4), and premenopause with the presence of estrogen acting as venous dila- tor (5-7). Regarding the clinical features of PCS, women experience pelvic pain for more than 6 months. Usually, pain appears during or after pregnancy, and has an incremental intensity pattern with the following pregnancies (8). Pain is commonly unilat- eral, but it can also be bilateral; patients describe this pain as a low intensity ache or heaviness that increments premenstrually or after physical activi- ty, prolonged standing or sexual intercourse. Other associated symptoms are urinary urgency, dysmen- orrhea, acute dyspareunia or intense pain exacer- bations (9); the patient frequently has perineal or even lower extremities varices (10). The physical examination reveals pelvic tenderness during both bimanual examination and direct palpation (3,8). Currently, there have not been formulated diag- nostic criteria for PCS. After excluding other causes