Seeing a Specialist About Pelvic Vein Symptoms
Which doctors assess pelvic congestion and pelvic vein disorders, whether you need a referral, what happens at a first consultation, and questions to ask, including if you are travelling to Singapore from the region.
When to see a doctor
Consider asking for an assessment if you have:
- A dull, dragging or heavy pelvic ache on most days for six months or more, especially if it is worse after standing and better lying down
- Pain during sex, or a deep ache that lasts for hours afterwards
- Varicose veins around the vulva, upper inner thigh, buttocks or back of the thigh
- Leg varicose veins that came back after treatment, especially after pregnancy
- Blood in your urine with left-sided flank pain, or swelling of the left leg
- A swelling or “bag of worms” feeling in the scrotum (men)
Get urgent care for sudden severe pain, heavy bleeding, fever with pelvic pain, fainting, or pain or bleeding when you might be pregnant. In Singapore, call 995 in an emergency.
Which specialist?
Pelvic vein problems sit between several specialties, which is one reason they are missed. The doctors most often involved are:
- Gynaecologists, who assess pelvic pain and check for conditions such as endometriosis, adenomyosis and fibroids
- Vascular surgeons, who specialise in veins and arteries and treat pelvic, leg and iliac vein problems
- Interventional radiologists, who perform image-guided treatments such as embolisation and stenting
- Urologists, for varicocele, and for blood in the urine that may point to nutcracker syndrome
Many women first see their family doctor (GP) or gynaecologist. If tests for other causes are clear and the pattern of pain fits, ask whether a venous cause has been considered and whether a pelvic vein scan would help.
Do you need a referral?
In Singapore you can usually see a private specialist directly. A referral from a GP or polyclinic is needed for subsidised care at a public hospital. Insurers may have their own rules on referrals and panel doctors, so check your policy before your first appointment. In other countries, the rules differ, so ask your family doctor or insurer.
What happens at the first consultation
- Your history. Where the pain is, how long you have had it, what makes it better or worse, how it relates to your periods and to sex, past pregnancies, and any previous tests or treatments.
- Examination. This may include checking your abdomen and looking for varicose veins on the vulva, thighs and legs. A pelvic examination may be needed; you can ask for a chaperone.
- A scan. Often a duplex ultrasound, which may be transabdominal, transvaginal or both. It looks at the size of your pelvic veins and the direction of blood flow.
- A plan. This may include further imaging such as CT or MR venography, a gynaecology review, trying medicines, or a discussion of embolisation.
Questions to ask
- What else could be causing my pain, and has it been ruled out?
- How sure are you that my veins are the cause?
- What are the options, including not having treatment?
- What are the chances this treatment will help me, and what are the risks?
- How many of these procedures do you do?
- What will it cost in total, and is it covered by MediSave or insurance?
Travelling to Singapore for assessment
If you are coming from Malaysia, Indonesia, the Philippines or elsewhere, bring copies of previous scans (the images, not just the reports), operation notes and a list of your medicines. Ask in advance how many visits are needed: assessment, imaging and embolisation may be done over several days, and you may be advised not to fly for a short time after a procedure. Ask for a written cost estimate before you travel.
Bring with you
- A short diary of your symptoms: when the pain is worst, and what helps
- Previous ultrasound, CT or MRI images and reports
- Results of any gynaecology, bowel or bladder investigations
- A list of your medicines, including hormonal contraception