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.   

Disclosing an STI: Tips on How to Tell Partners

Beginning a new romantic relationship can be an exciting and nerve-racking experience. As you get to know someone on a deeper level, it's natural to consider when and how to disclose personal information, including your sexual health status. If you have a sexually transmitted infection (STI), the question of when to disclose can feel daunting. This blog will discuss some considerations for navigating disclosure and finding the right time to share your STI status with a partner. Here are some things to consider before disclosing:

Understand the Importance of Disclosure  

The first step in navigating disclosure is understanding the importance of being honest and transparent with your partner about your STI status. Some people may wonder, do I legally need to disclose my STI? In some jurisdictions, disclosing your STI status is an ethical responsibility and a legal requirement. It allows your partner to make informed decisions about their sexual health, such as choosing a partner, understanding potential health risks, and taking necessary precautions, like using condoms or other barrier methods and keeping an eye out for sores, redness, or other STI symptoms. Additionally, open and honest communication about sexual health fosters trust and intimacy in a relationship.

Educate Yourself about Your STI

Educating yourself about your STI before disclosing your status is important. Understand how it's transmitted, the potential symptoms, treatment options, and ways to reduce the risk of transmission. This will enable you to have an informed conversation with your potential partner and answer any questions they may have.

Consider the Timing

When it comes to disclosure, timing is crucial. There's no one-size-fits-all answer as to when is the "right" time to disclose, as it depends on the dynamics of each relationship. Oftentimes, it can be helpful to have the conversation outside of a sexually charged environment and when both partners appear to be in an amiable mood. It's generally recommended to have a chat before any sexual activity occurs. This allows you and your partner to make informed decisions about the level of risk you're comfortable with. In contrast, having the conversation right before sex or after sex may produce mistrust between partners.

Create a Safe Space for Conversation  

You may be asking yourself if it is okay to disclose via text. Texting may not be the best option unless you are questioning your safety due to revealing it. Creating a safe conversation space is important when you decide to tell your STI status. Choose a private and neutral setting where you and your partner can feel comfortable and relaxed. Be open, non-judgmental, and willing to listen to their concerns or questions. Remember that the conversation should be two-way, allowing both parties to express their feelings and concerns.

Be Honest and Transparent

Honesty and transparency are the values at the heart of this concept we are exploring. Provide accurate information about your STI, including how you acquired it, if you're currently on treatment, and what steps you take to manage it. Avoid any temptation to downplay or minimize your STI status, as this can erode trust in the relationship.

For example, your conversation may sound like, “I want to have an open and honest conversation with you because I value our relationship and believe in transparency. Recently, I was diagnosed with [specific STI]. I want you to know I am taking proactive steps to manage my health, including following the recommended treatment plan and practicing safe sex. I understand the importance of disclosing this information to you so that you can make informed decisions about your health. I am here to answer any questions you may have and respect whatever decision you make moving forward. Our health and well-being are both important, and I believe that open communication is crucial in maintaining trust and understanding in our relationship.”

Anticipate Reactions and Prepare for Possible Outcomes

You may wonder if disclosing your STI will be a dealbreaker for your relationship. It's important to be prepared for various reactions from your potential partner when disclosing your STI status. They may have questions, concerns, or emotional responses. They may need time to process the information, seek further information, or discuss it with their healthcare provider. Be patient and understanding, allowing them to process their feelings.

Respect Your Partner's Decision

After disclosing your STI status, you must respect your partner's decision, whatever it may be. They may choose to continue the relationship with appropriate precautions, or they may decide that they're not comfortable moving forward sexually. Respecting their boundaries and choices without pressuring or guilt-tripping them is important. Remember that everyone has the right to decide about their sexual health.

Take Necessary Precautions

You may wonder if it is safe to continue dating someone who has disclosed an STI. If you and your partner are sexually active, consider taking precautions to prevent the transmission of STIs. This may include using condoms or other barrier methods, getting regular STI screenings, and following recommended treatment plans, such as taking an antiviral, if applicable. It's important to communicate openly with your partner about sexual health and continuously assess and mitigate the risk of transmission.

Prioritize Self-Care

Living with an STI can be emotionally challenging, and disclosure can bring up a lot of emotions. It's essential to prioritize self-care and seek support when needed. This may include talking to a therapist, joining support groups, or confiding in trusted friends or family members. Taking care of your emotional well-being can help you navigate disclosure and build healthy relationships.

Remember That Your STI Does Not Define You 

So is having an STI a big deal? It's important to remember that your STI status does not define your worth and value. Having an STI does not make you any less deserving of love, respect, and fulfilling relationships. It's just one aspect of your life. Be kind to yourself and practice self-compassion as you navigate disclosure and relationships.

Takeaway

Disclosing your STI status to a sexual partner can be a challenging but necessary step in building healthy relationships. With open communication, mutual respect, and understanding, building meaningful and fulfilling relationships is possible while managing your sexual health. Remember that every situation is unique, and it's essential to consult with a healthcare professional or a qualified therapist for personalized guidance and support in navigating disclosure and managing your sexual health.

Sexual Senescence: How Sexuality Changes with Age and What to Do About It

The only constant in life is change and sexuality is no exception. Over the course of a lifetime, a litany of factors will affect one’s sexuality and relationship with sex, including, but not limited to, age, biological sex, physical ability, hormonal changes, life circumstances, body image, and trauma. Even though it is common for one’s sexuality to evolve over a lifetime, the relationship between aging and sex, sometimes referred to as “sexual senescence,” remains shrouded in taboo and misconceptions. One such ageist misconception is that seniors do not experience sexual desire or have sex. This is an inaccurate assessment, many seniors do maintain a thriving sex life. In fact, many people feel that they have a more fulfilling sex life in older age because they know more about what they like and how to communicate it. This article is for seniors who want to have sex but are feeling limited by the effects of senescence. It will discuss the common limitations for seniors interested in having sex and how to address them.     

How does sex change with age?

Changes in sexual function are a common part of the aging process, though they are not universally experienced in the same way by all individuals. The impact of menopause and andropause is a key factor influencing sexual health and desire in later life. Medically speaking, menopause officially begins 12 months after a menstruating person’s last period. That being said, menopause is preceded by perimenopause, which can also present with symptoms that are disruptive to your sex life like lower libido. Menopausal people might experience vaginal dryness, atrophy, or a drop in estrogen levels, which can impact their enjoyment of sex. Similarly, andropausal people may experience a drop in testosterone levels and accordingly, erectile dysfunction which could impact their enjoyment of sex.

How can I improve my sexual health during aging?

Fortunately, there are some interventions to help with these hormonal changes. Lubricants, regular moisturizing, longer foreplay and estrogen therapy can help relieve vaginal dryness brought on by menopause. Andropause can cause erectile dysfunction which can be addressed with medications and healthful habits. Such medical interventions include testosterone therapy and oral medications like sildenafil or tadalafil. Consider talking to your doctor about your specific concerns and how to best address them.

Does sexual dysfunction increase with age?

Due to hormonal changes and other factors such as disability, medication, and energy levels, low libido is not uncommon among seniors. Depending on the cause of your low libido, the intervention will look different. Fortunately, you do not have to simply resign yourself to these obstacles and there are options for addressing low libido and desire discrepancy in a relationship.  

How do you maintain sexual health in older age?

Since conception is often less relevant in late adulthood, some people are tempted to take fewer precautions to practice safer sex. Unfortunately, age does not protect people from contracting sexually transmitted infections. This means it’s still important to use safer sex practices. Condoms, vaccinations, and regular testing are great ways to minimize the risk of STI transmission. 

 An active, fulfilling sex life is possible at any age. What is normal for one person or partnership varies, so it is most important to figure out how to approach sexuality as you age based on your specific needs. Remember that penetrative sex is not the only way to be intimate with someone. You could explore using sex toys, trying more solo and/or mutual masturbation, giving each other massages, oral sex, or skin to skin cuddling. As your needs, wants, and capabilities evolve, your approach to addressing them has to evolve too. If you have limitations due to aging that prevent you from engaging in specific sexual activities, that does not mean forgoing a great sex life.   

Takeaways

The most important part of navigating your evolving relationship with sexuality is to keep an open line of communication between you and your partner(s) about what you want and what works best for you in approaching your sex life. If you need emotional and logistical support figuring out how to supplement your sex life, consider working with a therapist.