(583) Pelvic Venous Congestion Syndrome and Dysorgasmia: A Case Report

Introduction Dysorgasmia – pain during or after orgasm – is a clinical condition with a challenging etiological diagnosis. Although its prevalence is estimated to range between 10% and 40%, it remains an underreported symptom among women and its pathophysiology is still poorly understood. Etiological factors include uterine and ovarian disorders, chronic inflammatory conditions, contraceptive use, pelvic floor dysfunction, as well as neurological, venous and psychological causes. Pelvic congestion syndrome is a condition characterized by dilated pelvic veins and accounts for approximately 20% of Gynecology appointments. During sexual arousal, the nervous system signals the relaxation of smooth muscles in the uterine and genital arteries that causes vasodilation, vasocongestion and uterine contractions. Pelvic congestion syndrome might be associated with pain during sexual intercourse, although the the underlying mechanism is not fully understood. Objective This clinical case reports a possible cause of dysorgasmia in a woman, as well as the diagnostic and therapeutic approach adopted. Methods We describe the case of a 61-year-old woman with a five-year history of suprapubic and right iliac fossa pain occurring immediately before orgasm and lasting for a few minutes until spontaneous resolution. She had no relevant past medical history besides chronic venous disease of the lower limbs and had no previous history of coital pain or difficulties achieving orgasm. Gynaecological and abdominal physical examination were normal. In order to find out a missed organic cause additional diagnostic complementary exams were requested. Results The transvaginal ultrasound identified a left posterolateral fibroid which was ruled out by Gynecology as the source of the symptoms. Due to the persistence of pain despite conservative treatment, namely pelvic floor muscle training, stretching and massage, a pelvic MRI was performed, that revealed ectasia of the right periuterine venous plexus. Given the patient's clinical history and risk factors this finding was considered to be the most likely cause for her complaints. She was referred to a multidisciplinary meeting, where a therapeutic trial with bioflavonoids and amitriptyline 10mg id was recommended until the next appointment. Conclusions The combination of ovarian point tenderness and postcoital pain has a sensitivity of 94% and specificity of 77% for pelvic congestion syndrome. However, the diagnosis is challenging and requires the exclusion of other organic causes of symptoms as the true impact of venous dilation on pelvic pain is controversial and may be influenced by many other factors that must be taken into account. The differential diagnosis of pelvic pain is broad, making etiological investigation a challenge. Awareness of pelvic congestion syndrome is essential, as it has a noteworthy estimated prevalence and should not be overlooked. Identifying this cause of dysorgasmia can significantly impact the biopsychosocial well-being of affected women and should be considered when no other organic etiology is evident. Disclosure No