Most information about pelvic congestion syndrome is written for women, so men with pelvic pain often wonder whether it could apply to them. The short answer is that men can have faulty pelvic veins, but pelvic venous congestion in men is a much less established idea than it is in women. This guide explains what the term can mean, what is and is not known, and which other causes of pelvic pain doctors look for first.
What is pelvic congestion syndrome?
In women, pelvic congestion syndrome is long-term pelvic pain linked to widened pelvic veins in which blood flows the wrong way. It is usually caused by faulty valves in the ovarian veins, and pregnancy is the biggest risk factor. Doctors now group it with related conditions under the term pelvic venous disorders.
Men do not have ovaries or pregnancies, so the female pattern does not transfer neatly. But men do have pelvic veins with valves, and those can fail too.
What can “pelvic venous congestion in men” mean?
When the term is used for men, it usually refers to one of these.
Varicocele: the most common form
A varicocele is a cluster of widened veins above the testicle. It happens when the valves in the testicular vein fail, so blood falls back and pools around the testicle. This is the same mechanism as ovarian vein reflux in women, which is why a varicocele is often called the male counterpart of pelvic congestion.
Varicoceles are common, found in about 15 in 100 men, and well studied. Some cause a dull, dragging ache that builds after standing and eases when lying down. Some are linked with fertility problems. If you search for “varicocele and pelvic congestion”, this is usually the link people mean.
Veins around the prostate and bladder
A network of veins surrounds the prostate and bladder. Scans sometimes show these veins widened, but this is common in men without symptoms, so a widened vein on a scan does not prove it causes pain.
A small number of case reports describe men with long-term pelvic pain in whom special X-ray tests of the veins showed reflux into veins around the prostate, bladder or perineum, sometimes after earlier varicocele surgery. One 2026 report described two such men whose pain settled after the veins were closed from the inside. Reports like these are interesting, but two patients cannot tell us how common the problem is or how well treatment works in general.
Nutcracker syndrome
In nutcracker syndrome, the left kidney vein is squeezed between two arteries. Blood backs up and can find its way down through the left testicular vein, causing a left varicocele, or through pelvic veins. Other signs can include left-sided flank pain and blood in the urine.
May-Thurner syndrome
In May-Thurner syndrome, the left iliac vein in the pelvis is pressed on by an artery. In men, it more often causes left leg swelling or a clot in the leg than pelvic pain.
How strong is the evidence?
It is important to be honest here. Pelvic congestion syndrome in men is a less established concept:
- There are no agreed criteria for diagnosing it in men
- Most published evidence is case reports and small case series
- There are no randomised trials of treatment in men with pelvic vein congestion outside the testicular vein
- Widened pelvic veins are often found in people without any pain
By contrast, varicocele and its treatment are well studied in men. If you are told you have “male pelvic congestion syndrome”, it is reasonable to ask what exactly was found, how the doctor knows it is causing your symptoms, and what the evidence is for any treatment offered.
Pelvic pain in men: what else could it be?
Long-term pelvic pain in men is common, and it is much more often due to something other than veins.
Chronic prostatitis / chronic pelvic pain syndrome
The most common diagnosis is chronic prostatitis / chronic pelvic pain syndrome (CP/CPPS). It is defined as pelvic pain lasting three months or more. Typical symptoms include:
- Pain in the perineum (between the scrotum and back passage), penis, testicles, lower tummy or lower back
- Pain when passing urine or after ejaculation
- Needing to pass urine often or urgently
Despite the name, most men with CP/CPPS do not have a bacterial infection. The cause is often unclear and may involve inflammation, tight pelvic floor muscles, nerve sensitivity and stress. Treatment usually combines several approaches, such as medicines, pelvic floor physiotherapy and psychological support. European urology guidelines on chronic pelvic pain recommend this kind of tailored, multi-part approach.
Other causes
Doctors will also think about:
- Inguinal hernia or groin strain
- Epididymitis or a past infection of the testicle
- Bladder pain syndrome or urinary stones
- Bowel conditions, such as irritable bowel syndrome
- Nerve irritation, such as pudendal nerve problems
- Problems with the lower back or hips
More than one cause can be present at the same time.
Pelvic venous congestion and erectile dysfunction
People sometimes search for a link between pelvic venous congestion and erectile dysfunction. There is little evidence that widened pelvic veins cause erection problems.
A different issue, sometimes called a venous leak (veno-occlusive dysfunction), happens when the penis cannot trap blood during an erection. That is a problem with how the erection tissue works, not pelvic vein congestion. Common causes of erectile dysfunction include blood vessel disease, diabetes, smoking, some medicines, low testosterone and stress. Because erection problems can be an early sign of heart disease, they are worth a check-up in their own right.
How is it investigated?
Your doctor will usually start with your history, an examination and simple tests, such as a urine test. If a vein problem is suspected:
- A scrotal ultrasound checks for a varicocele
- An abdominal ultrasound or CT or MR scan can look at the kidney and pelvic veins, including signs of nutcracker or May-Thurner syndrome
- A venogram, an X-ray of the veins using contrast dye, is usually done only by specialists, often at the same time as treatment
Treatment
Treatment depends on what is found:
- Varicocele. Surgery or embolisation are established options when a varicocele causes ongoing pain or fertility problems. See varicocele embolisation.
- Compression of a vein higher up. This is treated as part of nutcracker or May-Thurner syndrome care.
- Other pelvic veins in men. Embolisation has been reported in individual cases, but it should be seen as unproven and is usually offered only in specialist centres.
- CP/CPPS and other causes. Treated on their own terms, often with a combined approach.
Most writing on pelvic vein disease focuses on women. For background on how the condition is understood in women, see a Singapore vascular surgeon’s overview of pelvic congestion syndrome.
When to see a doctor
See your GP or a urologist if you have pelvic, groin, scrotal or perineal pain that has lasted more than a few weeks, pain with passing urine or ejaculation, a new lump in the scrotum, or blood in your urine. Our pelvic symptom check can help you organise your symptoms before an appointment.
Get urgent help for sudden, severe testicle pain, which may be testicular torsion. Also seek urgent care if you cannot pass urine, have fever or chills with pelvic pain, have severe one-sided pain with blood in the urine, or have a swollen, painful leg or sudden breathlessness, which can be signs of a blood clot. In Singapore, call 995 in an emergency.
Frequently asked questions
Can men get pelvic congestion syndrome?
Men can have faulty pelvic veins, but pelvic congestion syndrome as a diagnosis is mainly used for women. In men, the same problem most often appears as a varicocele, widened veins above the testicle. A few case reports describe men with pelvic pain linked to widened veins around the prostate or bladder, but this is not a well-established condition.
Is a varicocele the male version of pelvic congestion?
In many ways, yes. Both involve faulty valves in the vein that drains the sex organ, which is the testicular vein in men and the ovarian vein in women. Blood flows backwards and pools. In men it collects in the scrotum, where it can be felt; in women it collects deep in the pelvis.
Can pelvic venous congestion cause erectile dysfunction?
There is little evidence that widened pelvic veins cause erection problems. A different problem, sometimes called a venous leak, happens when the penis cannot trap blood during an erection. That is not the same as pelvic congestion. Erectile dysfunction has many common causes, so it is worth a check-up with your doctor.
Is there a physical therapy plan for pelvic congestion in men?
There is no proven physiotherapy plan for pelvic vein congestion itself. Pelvic floor physiotherapy is, however, a common and useful part of treatment for chronic pelvic pain in men, especially chronic prostatitis / chronic pelvic pain syndrome. A specialist pelvic health physiotherapist can assess you.
Which doctor should a man see for pelvic pain?
Start with your GP or a urologist. They can check for common causes such as prostatitis, infection, hernia and bladder or bowel problems. If a vein problem is suspected, you may be referred to a vascular surgeon or an interventional radiologist.
Sources and further reading
- Castiglione DG et al. Endovascular management of pelvic congestion syndrome in males: a report of 2 cases. Radiol Case Rep 2026;21(5):2049-55
- European Association of Urology — Guidelines on Chronic Pelvic Pain
- NHS — Prostatitis
- Society of Interventional Radiology — Pelvic venous disorders (patient information)
- CIRSE — Venous embolisation for varicocele (patient information, 2025)
This article is general information, not personal medical advice. Please speak to a doctor about your own symptoms. How we create our content.
