We thank Elizabeth Ball and Catherine Meads for their valuable comments with regard to our review on pelvic congestion syndrome.
We have stated in our paper that ‘Pelvic congestion syndrome (PCS) is a condition of pelvic varicosities in women with unexplained pelvic pain where it has been suggested as a cause of the chronic pelvic pain. However, there is a great deal of debate as to its definition and associated clinical features’. The relationship between PCS and chronic pelvic pain (CPP) is not well understood, in part because many of the research studies done to date have been of poor quality with bias. We fully agree that further evidence is needed. The types of trials mentioned by Ball and Meads will certainly help clear some of these issues.
A project may be underway by Professor Charles McCollum of the Education and Research Centre and University Hospital of South Manchester collaborating to research the symptoms suffered by women with pelvic vein incompetence and to conduct a major case–control study on pelvic vein incompetence in women with CPP syndrome. We look forward to the findings.
As mentioned in the PCS review ‘there is controversy with regard to the diagnosis of PCS as some clinicians are unwilling to acknowledge the existence of PCS as a clinical entity’. We agree with Ball and Meads that the uncertainty of the causation may be a factor in this. Further developments are needed to further evaluate diagnostic criteria, investigations and management options. Once there is more good quality evidence available, we are certain that there would be more awareness and acceptance of PCS as a clinical entity.