Dear Alice,

Is pelvic congestion a real and serious problem or just an easy answer for doctors who can't find another answer?

Dear Reader,

Indeed, pelvic congestion is a real and problematic condition. Most commonly experienced among women, pelvic congestion is a medical condition characterized by chronic, non-cyclic pelvic discomfort and pain lasting longer than six months. Up to one third of all women experience chronic pelvic pain at some point in their lives. The condition describes a transient state of discomfort, ranging from mild cramping to debilitating pain within all structures of the pelvis — including the pelvic muscles and ligaments, uterus, ovaries, and vulva. Pelvic congestion symptoms include achiness, pelvic heaviness, pressure, and rectal urgency (the urge to defecate occurs suddenly and intensely).

Pelvic congestion can be marked by consistent lower abdominal pain that worsens during menstruation — or while experiencing migraines, lower back pain, or other symptoms often associated with PMS (premenstrual syndrome). The pain can occur in any situation — while menstruating, sitting, standing, or during or after vaginal penetration — making sexual activity problematic, unpleasant, or impossible. Although less common among men, male pelvic congestion usually manifests in the prostate.

Some pelvic congestion is perfectly healthy. For example, when women become sexually aroused, they experience some degree of pelvic congestion caused by an increase of blood flow to the vagina and vulva. This congestion, which is normal and temporary, is usually relieved by an orgasm. If a woman does not orgasm, the congestion slowly subsides. However, it becomes a problem when the discomfort and pain associated with pelvic congestion becomes chronic or long lasting.

Explanations for pelvic congestion vary and research is ongoing. Pelvic congestion can be caused by pre-existing reproductive conditions, sexually transmitted infections, gastroenterological conditions, urinary conditions, or psychiatric conditions. The origin of pelvic pain is not very well understood because it’s not well researched, has many causes, includes a variety of symptoms, and has no clear or definitive treatment. Pelvic congestion is often misused as a universal explanation for unexplained pelvic symptoms when, in fact, other gynecological concerns could possibly be the true cause of discomfort or pain. Therefore, pelvic congestion is usually only considered after all other serious conditions are ruled out.

Diagnosing pelvic congestion by means of exclusion can be frustrating. It’s recommended that people get a second opinion after a thorough evaluation from a gynecologist or a health care provider. If pelvic congestion appears to be the most likely explanation for chronic pelvic discomfort or pain, the most basic treatment consists of taking hot baths and consuming over-the-counter naproxen sodium or ibuprofen to alleviate symptoms. If pelvic congestion symptoms are still problematic, other treatment options can be explored with a health care provider or gynecologist.

If you’re a Columbia student and would like to discuss symptoms or experiences of pelvic congestion, Morningside students may make an appointment at Medical Services through Open Communicator or by calling 212-854-2284. CUMC students can make an appointment with Student Health by calling 212-305-3400.


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