Imaging-based approach to venous-origin chronic pelvic pain

Chronic pelvic pain (CPP) is a debilitating condition affecting up to 26% of women worldwide. Among its many causes, pelvic venous disorders (PeVD) is increasingly recognized as an underdiagnosed contributor, often overlooked due to its non-specific presentation. PeVD results from venous reflux, or obstruction, leading to venous hypertension, congestion, and chronic pain. Advanced imaging techniques play a pivotal role in diagnosing PeVD, differentiating it from other etiologies of CPP. Ultrasound, particularly Doppler imaging, serves as the firstline modality for assessing venous reflux and dilation. Computed tomography and magnetic resonance venography provide detailed anatomical and haemodynamic evaluations, aiding in the identification of compressive syndromes and collateral pathways. Selective venography remains the gold standard, offering real-time visualization of reflux severity and guiding minimally invasive interventions such as venous embolization. Despite these advances, PeVD remains underrecognized in clinical practice, leading to delays in diagnosis and management. Increased awareness and standardized diagnostic criteria are crucial for improving patient outcomes. A multidisciplinary approach incorporating radiologists, gynecologists, and vascular specialists is essential for the comprehensive evaluation and treatment of PeVD. Emerging therapies, including endovascular techniques, offer promising options for symptom relief, reducing the need for invasive surgical procedures. This review highlights the pathophysiology, imaging modalities, and evolving management strategies for PeVD, emphasizing the importance of early recognition and intervention in patients with CPP.