Pelvic Congestion Syndrome: Causes, Symptoms, and Treatments

Chronic pelvic pain is a common occurrence among people assigned female at birth, affecting an estimated 15% of people of childbearing age in the United States. One of the causes of pelvic pain is pelvic congestion syndrome (PCS). PCS occurs when varicose veins develop around the ovaries. Varicose veins are twisted, enlarged veins that most often appear on the legs because standing and walking cause the blood to engorge the leg veins. Most of the time, varicose veins are completely benign and painless but when they appear on the ovaries, they can cause pain and discomfort. The exact cause is still unknown but pregnancy and estrogen can both play key roles in making the veins structurally unsound. Any type of chronic pain can be disruptive to your life so it is important to learn about the cause of your pain and what your treatment options are. This article will cover the symptoms of pelvic congestion syndrome, how it affects one’s sex life, and the treatment options that exist. 

What are the symptoms of pelvic congestion syndrome?

Dull and achy pelvic pain is the primary symptom of PCS, but it can manifest as a sharp pain as well. The pain can be exacerbated after standing or sitting for a long time, before and during menstruation or sexual activity. Additional symptoms include varicose veins in other places like the pelvis, buttocks, and vulva, an irritable bowel, stress incontinence, and pain with urination.   

How does pelvic congestion syndrome affect one’s sex life?

As mentioned above, pelvic congestion syndrome and the associated pain tends to be exacerbated by sexual intercourse. This not only poses physical obstacles to having sex, especially penetrative sex, but chronic pain can also cause a low libido. That does not mean that you can never achieve a fulfilling sex life though. In addition to the PCS treatment options below, there are ways to have great sex without penetration. You can engage in alternative forms of intimacy, like mutual masturbation, give and/or receive a sensual massage, or cuddle skin-to-skin. There are also ways to try to boost your libido, if you so desire. None of these options provide a permanent solution, but there are treatment options that can make it easier to live with PCS. 

   What are the treatment options for pelvic congestion syndrome?

Diagnosing pelvic congestion syndrome is not easy because the symptoms are easily conflated with other conditions and there is no test that will outright prove that PCS is the culprit. For this reason, doctors will typically run tests to rule out similar conditions, as well as use imaging like ultrasounds. Ultrasounds provide a view of the soft tissue; if more detailed imaging is required, a doctor may opt for an MRI or CT scan. The goal of diagnosis and treatment is to reduce or relieve pelvic pain, but there is unfortunately no known cure for PCS. The treatment you and your doctor pursue will depend on factors such as the severity of your symptoms and your medical history.

Treatment options for PCS may include: 

• Gonadotropin hormone drugs. Gonadotropins are hormones that regulate ovarian function; they are essential for growth, development, and reproduction functions. These drugs can block ovarian function and therefore relieve some pain.  

• Progestin hormone drugs. Similarly to gonadotropins, progestin drugs are hormonal drugs that serve to relieve pain by assisting the regulatory function of your reproductive system. 

• Sclerotherapy or embolization. A sclerotherapy is a typical treatment option for any varicose veins, including pelvic veins, such as is the case for PCS. It involves a needle that injects a solution which causes the damaged vein to scar and eventually fade as blood is rerouted to healthier veins. A similar concept but different execution is gonadal vein embolization is a minimally invasive treatment that involves a small incision for a tube that is used to dispatch a sclerosant that blocks the vein, therefore guiding the blood to healthier vessels, similar to how sclerotherapy works. 

• Oophorectomy or Hysterectomy (to remove your uterus and ovaries). An oophorectomy (removal of the ovaries) and hysterectomy (removal of the uterus) are reserved for the most severe cases of PCS after milder treatments have failed. However, these procedures have been shown to be a very effective treatment for PCS pain in treatment-resistant cases.

The Bottom Line

Pelvic congestion syndrome is a taxing condition that has the potential to significantly impact your quality of life, particularly your sex life. However, with a proper diagnosis and treatment plan, you can find relief. If you suspect you have PCS, you should consult with a healthcare professional to explore your options. Additionally, if you need extra support for your mental health and/or your libido and sex life due to the chronic pain, consider reaching out to a therapist.   

Why Do We Prioritize Romantic Over Platonic Love?

American society is obsessed with romantic love. From romantic comedies dominating box offices to holidays like Valentine’s Day to societal expectations of marriage as the ultimate goal, there is no shortage of conditioning to make people believe romantic love is more valuable and superior to platonic love. 

The philosopher Elizabeth Brake coined the term “amatonormativity” which, as defined in her book Minimizing Marriage: Marriage, Morality, and the Law, “refers to “the assumptions that a central, exclusive, amorous relationship is normal for humans, in that it is a universally shared goal, and that such a relationship is normative, in that it should be aimed at in preference to other relationship types.” The narrative that one is not complete without a lifelong, monogamous, and (ideally, in the eyes of society) heterosexual romantic partnership is enforced around every corner. This leads to people who don’t want that or can’t find that to feel defective.

In reality, there is nothing inherently more valuable about romantic love. When pressed, it’s tough to even put into words the actual distinction between romantic and platonic love. Some people might say it’s the physical intimacy, but what about people who can’t have sex but desire a romantic relationship for a variety of reasons like asexuality or depression or a physical limitation related to having sex? Are those people and their romantic connections any less valid? Of course not. Frankly, there is not a single satisfactory answer for what differentiates romantic relationships from platonic ones because it’s such a personal experience.

The tricky part of defining the differences between types of relationships is the disconnect between the breadth of the English language and the internal experience of emotions, which vary from person to person. How do you universally define a feeling? You can’t really, and when you try, that’s how people end up feeling excluded when their experience doesn’t align with the socially-enforced expectations they’ve internalized.

Contrary to what American society expects and conditions us to think, romantic and platonic love are simply different and neither is better nor worse. Romance does not have to be a part of your social life in order to feel fulfilled and loved.

This conversation is further complicated by feelings that don’t fit into either the traditional “romantic” or “platonic” definitions of relationships. There are queerplatonic relationships, sexual relationships without a romantic or platonic element, and purely aesthetic attraction, to name a few examples outside the romantic/platonic binary. With the nuances and intricacies of human emotion, it makes sense that a simple binary couldn’t possibly encapsulate the realm of possibility for relationship forms. There are more options open to us than societal conditioning has led us to believe. 

The bottom line is that you should navigate your relationships and prioritizing them however feels right to you, your needs, and your loved ones. There is nothing wrong with being happy as a single person or prioritizing fulfillment in other areas of your life over romance, like friendships. Just because society is telling you that in order to feel fulfilled you need a romantic partner does not make it true.

All About Lube: Which kind is right for you?

Lubricant is perhaps one of the most versatile sex accessories out there. It’s a liquid or gel that mitigates unwanted friction during sex, making it a more comfortable experience. Nearly every sexually active person could benefit from having a dependable lube (or two or three) on hand. It’s even more handy for vulva-owners who can’t produce as much wetness as they’d like whether that’s due to aging, birth control, medication, or something else.

These days, there are a variety of lubes with different functions, from the classic friction-fighters to tingles, warming sensations, and more! No lube is one size fits all, and depending on what you plan to use it for, you’ll have to select accordingly. Some of the factors to consider are whether you’ll use it solo or with a partner, if the sex will be penetrative, whether you want to use it with sex toys (and if so, what material those sex toys are comprised of). This article serves as a guide to help you figure out which lube is right for you!    

Water-based

Water-based lube is the most common type of lubricant. The benefits of using water-based lube are affordability and accessibility, easy clean up from skin and fabric, and they’re safe to use with condoms and every sex toy material. In terms of drawbacks, water-based lubes are absorbed into the skin quicker than their counterparts, leaving some sticky residue (which can be a drawback for those with sensory issues) and therefore you might have to reapply more frequently. Additionally, be on the lookout for water-based lubes that have a low osmolality, which means they have a higher degree of the product and few to no chemical ingredients because lubes with high osmolality are more likely to cause irritation.

Recommended water-based lubes:

• LOLA Personal Lubricant, $15 

• Good Clean Love Liquid Personal Lube, $11

• Sliquid H2O, $10     

Oil-based

Oil-based lube is a very slippery, long-lasting option that even doubles as a massage oil! The extremely important-to-note caveat is that it cannot be used with condoms because it will degrade them. Another drawback is that they often will stain fabric.

Recommended oil-based lubes:

• Coconut Oil-Based Lubricant, $25

• AH! YES Organic Lubricant, $22    

Silicone-based

The longest lasting of the lubricants, silicone-based lubes are beloved for their endurance. They’re also the most popular lube for anal sex due to their durability. Plus, they even hold up under water, if shower sex is your jam. Like water-based lubes, silicone is safe to use with latex condoms. The drawbacks are that silicone lube is harder to remove from skin and fabric, it tends to be more expensive, and it can’t be used with any silicone-based sex toys because they will degrade.

Recommended silicone-based lubes:

• Wet Platinum Premium Pure Silicone Personal Lube, $10

• Sliquid Silver, $30

• pjur BACK DOOR Silicone-based, $39

Hybrid lubricants

Hybrids are a mix of silicone and water lube to make it last longer. It won’t affect silicone toys in the way pure silicone lube will, and it offers easier cleanup than silicone too.

Recommended hybrid lubes:

• Wicked Hybrid, $29

• Good Clean Love Hybrid (contains glycerin), $12 

Sensory lubricants

Sensory lubricants are lubes that are formulated to make you feel a sensation like warming or tingling. They’re a fun way to spice up your sex routine and try something new. Sometimes the ingredients needed to make the sensation can be irritants though (see ingredients to steer clear of below) so it’s important to be on the lookout for that.

Recommended sensory lubes:

• Sliquid Organics Sensation-Amplifying Lube, $12

• Dame Arousal Serum (might need to be paired with a lubricant to add slipperiness), $30

• Sliquid Sizzle Warming Lube, $28

• Ultra Chill Cooling Silicone Lube by Wicked Sensual Care, $24     

Lube ingredients to avoid

For every healthy lube on the market, there’s an equal number of cheaply made, irritant-filled lubes too. When you’re searching for your perfect lube, keep an eye on the ingredients list and try to avoid the following. If you’re curious about why you should avoid each, check out this Self article and this extremely comprehensive Phallophile Reviews guide.

• Glycerin

• Nonoxynol-9

• Petroleum

• Propylene glycol

• Parabens (usually methylparaben)

• Chlorhexidine gluconate

• Diazolidinyl urea

• Polyquarternium-15

On the topic of lubes to avoid, though you might be tempted to use household products like baby oil, olive oil, or Vaseline - steer clear! Products that are not meant to be used in sensitive areas are comedogenic, can cause skin irritation and/or infection, and can alter vaginal pH. In a pinch you can try using something like coconut oil but that shouldn’t be your first choice and it does pose the aforementioned risks.

Since lube touches the most sensitive areas of your body, it’s important to find a compatible, safe option for your life and anatomy. It may take some trial and error to figure out your favorite but it’s worth it! A good lube can make all the difference and improve the pleasurability of solo or partnered sex.