Pelvic venous disorders in chronic pelvic pain care in Türkiye: A cross-sectional e-survey among obstetricians and gynaecologists

Abstract

Objectives

To investigate how obstetricians’ and gynaecologists’ self-rated familiarity with pelvic venous disorders (PeVD), including pelvic congestion syndrome (PCS), and local interventional access relate to self-reported recognition, diagnostic choices, and management pathways in chronic pelvic pain (CPP) care.

Methods

We conducted an anonymous web-based survey of obstetricians and gynaecologists involved in CPP care in Türkiye between January 2026 and February 2026. Outcomes were frequency of considering PCS/PeVD, self-reported annual PCS diagnoses, first-choice imaging, clinical approach, and treatment knowledge. Ordinal proportional-odds and multinomial logistic regression models adjusted for age, gender, years in practice, institution type, and monthly CPP volume; interventional radiology/embolisation availability was added where clinically relevant. The invitation denominator could not be reliably enumerated, so no response rate was calculated.

Results

Among 528 respondents, 79.8% considered PCS/PeVD at least sometimes and 20.3% considered it very rarely. In the past year, 25.2% reported no PCS diagnoses, 58.9% reported 1–5, 12.5% reported 6–10, and 3.4% reported >10. Transvaginal Doppler ultrasound was the most common first-choice imaging modality (78.4%). Limited self-rated familiarity was associated with lower odds of more frequent consideration (aOR 0.25, 95% CI 0.17–0.37), whereas university-hospital setting was associated with higher consideration frequency (aOR 2.94, 95% CI 1.29–6.69). On-site embolisation availability was associated with a lower relative risk of choosing no PCS-specific treatment versus conservative management (RRR 0.23, 95% CI 0.06–0.84). Limited familiarity was also associated with lower treatment knowledge (aOR 0.42, 95% CI 0.29–0.61).

Conclusions

Self-rated familiarity and local interventional access were associated with self-reported PCS/PeVD recognition and management choices. These exploratory associations should be interpreted cautiously because key exposure and outcome measures were subjective and partly overlapping. PeVD-oriented education, ultrasound training, and clearer multidisciplinary referral routes warrant prospective evaluation.

Keywords

pelvic venous disorders pelvic congestion syndrome chronic pelvic pain survey ultrasound embolisation

Get full access to this article

View all access options for this article.

References

Meissner

Khilnani

Labropoulos

, et al. The symptoms-varices-pathophysiology classification of pelvic venous disorders: a report of the American vein. Lymphatic Society International Working Group on Pelvic Venous Disorders. Phlebology 2021; 36(5): 342–360.

Gadhoke

Bahethi

Lakhanpal

, et al. Application of the symptoms-varices-pathophysiology classification system in patients with pelvic venous disorders. Phlebology 2024; 39(8): 543–549. https://doi.org/10.1177/02683555241257155

Khilnani

Meissner

Learman

, et al. Research priorities in pelvic venous disorders in women: recommendations from a multidisciplinary research consensus panel. J Vasc Intervent Radiol 2019; 30(6): 781–789. https://doi.org/10.1016/j.jvir.2018.10.008

Whiteley

Imran

. Pelvic venous disorders (PeVD) are not well represented in obstetrics and gynaecology journals. Phlebology 2025; 40(6): 441–445. https://doi.org/10.1177/02683555251314285

Le Pennec

Douane

Brun

, et al. Endovascular management of pelvic congestion syndrome: an expert consensus statement. Diagn Interventional Imaging 2025, Epub ahead of print.

Kavallieros

Pope

Tan

, et al. Identification of outcomes in clinical studies for pelvic venous disorders. J Vasc Surg Venous Lymphat Disord 2024; 12(6): 101865. https://doi.org/10.1016/j.jvsv.2024.101865

Baccellieri

Basile

Arena

, et al. Delphi consensus on diagnostic and therapeutic pathways for pelvic venous disorders - a multidisciplinary algorithm. Vasa 2026. https://doi.org/10.1024/0301-1526/a001267

Labropoulos

Jasinski

Adrahtas

, et al. A standardised ultrasound approach to pelvic congestion syndrome. Phlebology 2017; 32(9): 608–619. https://doi.org/10.1177/0268355516677135

Whiteley

Dos Santos

Harrison

, et al. Transvaginal duplex ultrasonography appears to be the gold standard investigation for the haemodynamic evaluation of pelvic venous reflux in the ovarian and internal iliac veins in women. Phlebology 2015; 30(10): 706–713. https://doi.org/10.1177/0268355514554638

10.

White

Holdstock

. Ultrasound assessment of pelvic venous reflux. Indian J Vasc Endovasc Surg 2018; 5(4): 234–243. https://doi.org/10.4103/ijves.ijves_84_18

11.

Gavrilov

Moskalenko

Kulikov

, et al. Protocol for duplex ultrasound study of the pelvic veins in women. Phlebology 2025; 40(6): 420–430. https://doi.org/10.1177/02683555241311445

12.

Fernandes

Storino

Barros

, et al. Transvaginal ultrasound approach for diagnosing pelvic venous disorders. J Vasc Surg Venous Lymphat Disord 2025; 13(6): 102286. https://doi.org/10.1016/j.jvsv.2025.102286

13.

Dorobisz

Garcarek

Kurcz

, et al. Diagnosis and treatment of pelvic congestion syndrome: single-centre experiences. Adv Clin Exp Med 2017; 26(2): 269–276. https://doi.org/10.17219/acem/68158

14.

Steenbeek

van der Vleuten

Schultze Kool

, et al. Noninvasive diagnostic tools for pelvic congestion syndrome: a systematic review. Acta Obstet Gynecol Scand 2018; 97(7): 776–786. https://doi.org/10.1111/aogs.13311

15.

Bookwalter

VanBuren

Neisen

, et al. Imaging appearance and nonsurgical management of pelvic venous congestion syndrome. Radiographics 2019; 39(2): 596–608. https://doi.org/10.1148/rg.2019180159

16.

Valero

Garcia-Jimenez

Valdevieso

, et al. Identification of pelvic congestion syndrome using transvaginal ultrasonography: a useful tool. Tomography 2022; 8(1): 89–99. https://doi.org/10.3390/tomography8010008

17.

Bałabuszek

Toborek

Pietura

. Comprehensive overview of the venous disorder known as pelvic congestion syndrome. Ann Med 2022; 54(1): 22–36. https://doi.org/10.1080/07853890.2021.2014556

18.

Knuttinen

Machan

Khilnani

, et al. Diagnosis and management of pelvic venous disorders: AJR expert panel narrative review. AJR Am J Roentgenol 2023; 221(5): 565–574. https://doi.org/10.2214/AJR.22.28796

19.

Szaflarski

Sosner

French

, et al. Evaluating the frequency and severity of ovarian venous congestion on adult computed tomography. Abdom Radiol 2019; 44(1): 259–263. https://doi.org/10.1007/s00261-018-1707-9

20.

Pitoulias

Andrioti Petropoulou

Bontinis

, et al. Ultrasonography in the diagnosis of pelvic vein insufficiency: a systematic review and meta-analysis. Phlebology 2025; 40(6): 386–394. https://doi.org/10.1177/02683555241312780

21.

Szkodziak

Woźniak

Kudła

, et al. The usefulness of transvaginal ultrasonography in the diagnosis of pelvic venous disorders. Sci Rep 2025; 15(1): 24776. https://doi.org/10.1038/s41598-025-10311-8

22.

Chen

Kao

, et al. Pelvic congestion syndrome analysis through quantitative 2-dimensional phase-contrast MRI: a promising vision from an observational cohort study. Int J Surg 2024; 110(10): 6470–6483. https://doi.org/10.1097/JS9.0000000000001810

23.

Senechal

Echegut

Bravetti

, et al. Endovascular treatment of pelvic congestion syndrome: visual analog scale follow-up. Front Cardiovasc Med 2021; 8: 751178. https://doi.org/10.3389/fcvm.2021.751178

24.

Daniels

Champaneria

Shah

, et al. Effectiveness of embolisation or sclerotherapy of pelvic veins for reducing chronic pelvic pain: a systematic review. J Vasc Intervent Radiol 2016; 27(10): 1478–1486. https://doi.org/10.1016/j.jvir.2016.04.016

25.

Champaneria

Shah

Moss

, et al. The relationship between pelvic vein incompetence and chronic pelvic pain in women: systematic reviews of diagnosis and treatment effectiveness. Health Technol Assess 2016; 20(5): 1–108. https://doi.org/10.3310/hta20050

26.

O’Brien

Gillespie

. Diagnosis and treatment of the pelvic congestion syndrome. J Vasc Surg Venous Lymphat Disord 2015; 3(1): 96–106. https://doi.org/10.1016/j.jvsv.2014.05.007

27.

Mahmoud

Vikatmaa

Aho

, et al. Efficacy of endovascular treatment for pelvic congestion syndrome. J Vasc Surg Venous Lymphat Disord 2016; 4(3): 355–370. https://doi.org/10.1016/j.jvsv.2016.01.002

28.

Guirola

Sánchez-Ballestin

Sierre

, et al. A randomized trial of endovascular embolisation treatment in pelvic congestion syndrome: fibered platinum coils versus vascular plugs with 1-year clinical outcomes. J Vasc Intervent Radiol 2018; 29(1): 45–53. https://doi.org/10.1016/j.jvir.2017.09.011

29.

Clark

Taylor

. Pelvic venous disorders: an update in terminology, diagnosis, and treatment. Semin Interv Radiol 2023; 40(4): 362–371. https://doi.org/10.1055/s-0043-1771041

30.

Sutanto

Tan

Onida

, et al. A systematic review on isolated coil embolisation for pelvic venous reflux. J Vasc Surg Venous Lymphat Disord 2022; 10(1): 224–232. https://doi.org/10.1016/j.jvsv.2021.07.006

31.

Bałabuszek

Toborek

Pietura

. Symptoms and quality of life assessment after coil and foam embolisation in patients with venous-origin chronic pelvic pain (VO-CPP)-a subgroup of pelvic venous disorders (PeVD). Ann Med 2025; 57(1): 2570798. https://doi.org/10.1080/07853890.2025.2570798

32.

Pyra

Zbroja

Cyranka

, et al. Pelvic congestion syndrome: a still underdiagnosed cause of chronic pain in premenopausal women. Pol Arch Intern Med 2021; 131(2): 187–189.

33.

Kaufman

Little

. Pelvic congestion syndrome: a missed opportunity. Indian J Radiol Imag 2021; 31(3): 539–544. https://doi.org/10.1055/s-0041-1735497

34.

Marcelin

Izaaryene

Castelli

, et al. Embolization of ovarian vein for pelvic congestion syndrome with ethylene vinyl alcohol copolymer (Onyx). Diagn Interventional Imaging 2017; 98(12): 843–848. https://doi.org/10.1016/j.diii.2017.05.011

35.

von Elm

Altman

Egger

, et al. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 2007; 370(9596): 1453–1457. https://doi.org/10.1016/s0140-6736(07)61602-x

36.

Eysenbach

. Improving the quality of web surveys: the checklist for reporting results of internet E-Surveys (CHERRIES). J Med Internet Res 2004; 6(3): e34. https://doi.org/10.2196/jmir.6.3.e34

37.

Storino

Barros

Cardoso

. Anatomical patterns of pelvic venous reflux to the lower limbs. J Vasc Surg Venous Lymphat Disord 2026; 14(4): 102507. https://doi.org/10.1016/j.jvsv.2026.102507

38.

Gavrilov

Moskalenko

Karalkin

, et al. Pelvic vein thrombosis in patients with pelvic venous disorders. Phlebology 2024; 39(8): 534–542. https://doi.org/10.1177/02683555241256264

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.56 MB