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Pelvic congestion syndrome in men – rare but worth considering

  • News
  • 5 min read

Pelvic congestion syndrome in men refers to symptomatic dilated veins in the male pelvis causing discomfort and pain. Compared with women it is uncommon but is worth considering as a cause of chronic pelvic pain or atypical varicose veins in the legs.

What other symptoms of pelvic congestion syndrome (PCS) should I look for?

Other conditions linked to pelvic congestion syndrome in men include:

  • Varicocele: or varicose veins around the testicles, usually affecting one side only. Testicular pain is a common symptom, and there may be an association with low sperm count and male infertility.
  • Varicose Veins: most varicose veins start in the legs but PCS can be a cause of atypical varicose veins that start in the pelvis and spread down into the legs .
  • Scrotal veins: these are varicose veins in the skin of the scrotum.
  • DVT: or deep vein thrombosis, when DVT has caused blockage or damage to the main veins in the pelvis, varicose veins or increased pressure within the pelvic veins may occur, causing symptoms. 
  • Venous compression syndromes: examples are May-Turner Syndrome (MTS) and Nutcracker Syndrome (NS). With these the normal large veins are compressed by surrounding structures, causing a restriction in flow through the vein and increased pressure. Some inherited genetic syndromes such as Ehlers-Danlos Syndrome (EDS), make MTS and NS more likely.
Other symptoms include varicose veins around the testicles.

What are the symptoms of pelvic congestion syndrome in men?

Pelvic congestion syndrome linked to chronic pelvic pain, may worsen if standing for too long or over exercising. A dull ache in the testicals, more often on the left side, and usually worse when upright, standing or straining. There may be a lump or you can see varicose veins. If you notice a lump please see your general practitioner (GP) as soon as you can.

Varicose veins or smaller spider veins may be visible on the scrotum. The scrotum may be swollen as a result. – pain is always linked with the swelling. Pain during or after ejaculation. You may also feel pain in the legs from varicose veins that began in the pelvis and then spread to the legs. Coupled with these symptoms, men may be stressed, anxious and suffer depression.

How does pelvic congestion syndrome affect trans men?

Pelvic congestion syndrome is more commonly associated with people assigned female at birth. However, it can occur in trans men who have had hormone therapy but retain their reproductive organs. The symptoms of pelvic congestion syndrome in trans men are similar to those of females, including:

  • Chronic pelvic pain, often said to be persistent, dull and achy that gets worse during the day
  • Pain during or following intercourse
  • Irregular menstrual bleeding or worsening of menstrual symptoms in trans men who have not had a hysterectomy
  • Lower back pain that may move to the hips or thighs
  • Urinary issues like pressure or the need to go more often and sometimes with urgency.

Diagnosing pelvic congestion syndrome in trans men can be hard due to the overlap of symptoms with other pelvic-related disorders. The condition is also rare. Tests such as ultrasound or MRI are needed to see the pelvic veins and assess blood flow. Other treatment options for trans men who have not had hormone therapy may include starting testosterone therapy, as this can induce amenorrhea and help reduce menstrual symptoms.

What are the steps to diagnosis?

For any pelvic pain please see your GP first. They may refer you for an ultrasound scan. An ultrasound uses sound waves to assess tissues and blood flow. Your GP may refer you for a more detailed x-ray. The x-ray will look at your abdomen, pelvis and testicles and scrotum.

Your GP may refer you for an ultrasound scan of your pelvis.

What are the treatment options for pelvic congestion syndrome in men?

Your GP may recommend some simple things you can do to relieve discomfort. Including not sitting or standing for long times, keeping a healthy weight and exercising regularly. Wearing supportive underwear may also help with symptoms. 

Treatment depends on the cause and how bad the symptoms are. Some over-the-counter pain relief like paracetemol or ibuprofen may help. Minimally invasive treatments, like stents that open up narrowed or blocked veins and embolisation that close down leaking veins, can relieve pain. Finally, surgery may be suitable for people with worsening symptoms and for whom quality of life is being impacted.