Published Research

Could Pelvic Veins Be an Overlooked Cause of Chronic Pelvic Pain?

Research Summary | IN Radiology

Chronic pelvic pain can be difficult to investigate, particularly when routine imaging does not identify a clear cause. While conditions such as endometriosis and adenomyosis are commonly considered, abnormalities in the pelvic veins may also contribute to persistent symptoms.

A recently published article in the Australasian Journal of Ultrasound in Medicine, led by Kristelle Sos, Head Sonographer at IN Radiology, highlights the importance of recognising pelvic venous disorders (PeVD) as a potential contributor to chronic pelvic pain.

What are pelvic venous disorders?

Veins carry blood back towards the heart. Inside many veins, small valves help keep blood moving in the right direction.

When these valves do not function properly, blood can flow backwards. This is known as venous reflux. In the pelvis, this can contribute to increased venous pressure and the development of enlarged veins around the pelvic organs.

For some women, these changes may be associated with persistent pelvic discomfort, including a dull or aching sensation that can worsen after prolonged standing.

However, enlarged pelvic veins do not automatically indicate disease, and pelvic pain can have several contributing causes.

Why might these conditions be missed?

Pelvic ultrasound is commonly used to investigate persistent pelvic pain, particularly when clinicians are looking for abnormalities involving the uterus, ovaries or surrounding structures.

However, routine pelvic ultrasound examinations do not always include a detailed assessment of blood flow within the pelvic veins.

This means that potential signs of pelvic venous disorders may go unrecognised, particularly when the more commonly investigated structures appear normal.

How can ultrasound help?

The article highlights the potential value of transvaginal Doppler ultrasound, which allows clinicians to assess not only the appearance of pelvic veins but also the direction and characteristics of blood flow.

Vein diameter alone cannot reliably establish whether a pelvic vein is functioning abnormally. Doppler ultrasound can identify venous reflux, providing additional information when assessing possible pelvic venous incompetence.

The authors advocate for incorporating targeted venous assessment into pelvic ultrasound examinations to improve recognition of potential abnormalities and guide further investigation or specialist referral when appropriate.

What does this mean for patients?

For women experiencing persistent pelvic pain, particularly when previous investigations have not identified a clear explanation, pelvic venous disorders may warrant consideration alongside other possible causes.

At IN Radiology, Kristelle routinely performs pelvic venous assessments, bringing her clinical experience in this area directly into patient care.

The publication encourages greater awareness of pelvic venous disorders and a more comprehensive approach to investigating chronic pelvic pain.

Pelvic venous disorders represent another potential contributor to chronic pelvic pain. Assessing venous blood flow alongside pelvic anatomy may identify abnormalities that conventional imaging does not routinely investigate.

Original publication

Sos, K., Lobos, C. A., Wilcox, K., & Wilcox, S. (2026). It's time to recognise pelvic venous incompetence as a cause of chronic pelvic pain. Australasian Journal of Ultrasound in Medicine.

https://doi.org/10.1002/ajum.70066