Endovenous Embolization of Pelvic Congestion Syndrome: Impact on Pain, Sexual Function and Quality of Life - A Multidisciplinary Prospective Single-Arm Cohort Study

OBJECTIVE: This prospective cohort study evaluated the impact of endovenous ovarian vein embolization (OVE) on pain, sexual function, psychiatric symptoms, and quality of life in pelvic congestion syndrome (PCS). METHODS: Eighty females with PCS aged 18-55 years presenting with chronic pelvic pain (VAS ≥4) lasting ≥6 months underwent OVE. Patients with confirmed pelvic venous reflux on venous reflux Doppler ultrasonography (VRDUS) using 3-5 MHz probes in supine and standing positions were classified using the 2021 Symptoms-Varices-Pathophysiology (SVP) system. Outcomes were assessed at baseline, 3, and 6 months using Visual Analog Scale (VAS), Female Sexual Function Index (FSFI), Arizona Sexual Experiences Scale (ASEX), Hamilton Depression (HAM-D) and Anxiety (HAM-A) scales, and SF-36 quality of life instrument. Statistical analysis included paired t-tests, Cohen's d effect sizes, and multivariate logistic regression. A priori power analysis (G*Power 3.1, Cohen's d=0.8, power=0.95) required minimum 68 participants. Patient recruitment occurred between February 2025 and August 2025, with 6-month follow-up assessments completed by February 2026. RESULTS: Mean age was 36.7±4.6 years; parity 3.6±1.4. Most patients (67.5%) were S2-V2-PBGV,R,NT classification. At 6 months, significant improvements occurred: VAS decreased 3.12±2.51 points (Cohen's d=1.68, p<0.001), FSFI increased 7.28±4.86 (d=1.21, p<0.001), ASEX decreased 9.45±6.34 (d=1.47, p<0.001), HAM-D decreased 6.8±3.6 (p<0.001), HAM-A decreased 8.1±4.2 (p<0.001), and quality of life increased 28.42±16.15 (d=2.24, p<0.001). Response rates were 88.7% (VAS/QoL), 86.2% (FSFI), and 87.5% (ASEX). Pelvic pain decreased in 93.7%, dyspareunia improved in 91.2%, and vaginismus resolved in 95.2%. Minor complications occurred in 6.25%. Dysmenorrhea (OR=3.24), high parity (≥4 births; OR=2.87), and prolonged symptom duration (≥2 years; OR=2.15) were independent predictors of response. CONCLUSION: Endovenous OVE provides sustained, multidimensional improvement in PCS, significantly enhancing sexual function, psychiatric health, and quality of life. While the single-arm design limits causal attribution, the high response rates and favorable safety profile substantiate significant clinical benefit. The multidisciplinary management approach validates the importance of integrating vascular surgery and psychiatry.