5D Syndrome – what does it stand for?

'This is normal,’ ‘all women experience this,’ ‘it will resolve after childbirth,’ ‘take an analgesic and don’t overreact’—if you have encountered such statements in a medical setting when describing pain during sexual intercourse or in the early days of menstruation, you are not alone. Hundreds of millions of women worldwide continue to believe that suffering is intrinsic to their biology, maturation, and daily existence. Pain is frequently portrayed as the inevitable price of womanhood.

What if you were informed that your symptoms might have a distinct underlying cause—something that, even as late as the late 20th century, remained poorly recognized or insufficiently studied? The Phlebology Clinic Team For many years, I have been managing patients who, alongside evident venous manifestations such as varicosities and telangiectasias, present with dysmenorrhea, menorrhagia, defecation difficulties, dysuria, and dyspareunia.

Extensive clinical observations and experience in managing thousands of patients with pelvic venous insufficiency (NZM) has enabled the physicians of the Phlebology Clinic to identify and characterize a distinct constellation of symptoms, which we have designated as „'5D Syndrome'„. This authorial diagnostic framework encompasses five principal symptoms characteristic of women with pelvic venous insufficiency and/or endometriosis.

The concept of the 5D Syndrome was developed to raise awareness among patients and and physicians across all medical specialties (with particular emphasis on gynecologists and phlebologists) to the observation that these five symptoms These symptoms frequently co-occur and may have a shared pathophysiological basis. Contemporary medicine should move away from addressing each disorder in isolation and adopt a holistic approach to patient care. It is also important to equip patients with terminology that facilitates precise communication with physicians—medical terms that are less likely to be minimized compared to a nonspecific remark such as: ‘I experience lower abdominal pain during menstruation.’

So, what exactly is the so-called '5D Syndrome'? We encourage you to continue reading 😊

Why it is important to be aware of these the five symptoms (5D)?

The 5D Syndrome it is a group of five symptoms, whose professional name which begins with the letter ‘D’These symptoms fall within the symptomatology of two often overlooked and underdiagnosed conditions, such as pelvic venous insufficiency (PVI) of the female type and endometriosis. Collectively, these two diseases impact approximately 20–25% of the female populationmoreover, some of their typical symptoms overlap to such an extent that it can sometimes be difficult to distinguish between them without specialized knowledge, diagnostic tools, and clinical experience

What constitutes the 5D Syndrome?

1. Dysmenorrea – when menstruation becomes extremely painful

Dysmenorrhea (painful menstruation) affect up to 70–80% of women with endometriosis. These are not ordinary cramps that go away with painkillers. This is pain that can immobilize you for several days, often starting before bleeding and sometimes lasting throughout the entire menstruation. In the case of pelvic venous insufficiency (PVI), hormonal fluctuations during the cycle further dilate the insufficient veins, worsening the symptoms. Women—often completely unknowingly—frequently experience ‘micro-thrombotic events’ in the dilated venous plexuses around the reproductive organs during their cycle. This generates pain similar to adnexal inflammation. Have you ever had elevated D-dimer levels while a gynecologist performing a transvaginal ultrasound found no cause of the pain and prescribed antibiotics? Remember, if you need to take time off work every month due to menstrual pain, it is a signal that something serious is happening.

2. Dyschezia - a problem that no one talks about

Dyschezia (painful defecation) Dyschezia remains a largely taboo subject, yet it should not be overlooked. This symptom occurs in 20–50% of women with deeply infiltrating endometriosis (DIE). In cases of pelvic venous insufficiency, venous congestion affects both the intestinal mucosa and the pelvic floor muscles, including the levator ani, resulting in distressing and uncomfortable manifestations. Dyschezia is frequently associated with chronic bloating, constipation, and a sensation of incomplete evacuation. Does this sound familiar?

3. Dysuria – when urination becomes extremely painful and distressing

Symptoms such as dysuria, increased urinary frequency, a sensation of incomplete bladder emptying, or hypersensitivity disrupting sleep are frequently misattributed to recurrent urinary tract infections in women. However, these manifestations may be linked to endometriosis or pelvic venous insufficiency (PVI). In PVI, the condition can be particularly complex. Venous congestion affects the urethra and bladder, mimicking symptoms of cystitis, while the heaviness and enlargement of the congested uterus can impinge upon the filling bladder, exacerbating discomfort.

4. Dyspareunia – a condition that disrupts your intimate life

Our observations indicate that women feel the most embarrassed to talk about this problem. Pain (or discomfort) during intercourse it affects approximately 50% of women with endometriosis and a significant proportion of women with pelvic venous insufficiency. Dyspareunia the pain is not limited to the act of penetration; it may continue for several hours post-coitus, significantly impacting sexual well-being and quality of intimate life.
Interestingly, in pelvic venous insufficiency, this problem occurs more frequently and is more complex. Burning or pain symptoms (resulting from excessive congestion of the uterine body, cervix, vagina, perineum, and vulva) often appear even before intercourse, during sexual arousal. Later—during intercourse—they intensify. Venous congestion significantly disrupts sexual function, causing pain instead of pleasure. Pain that persists after intercourse (so-called postcoital pain) leads to sexual avoidance in women. This is a characteristic feature of the so-called venous dyspareunia. And this brings us to the final symptom in the 5D group.

5. Dysorgasmia – the least known and least obvious symptom

Pain during or after orgasm is a problem that is rarely discussed, yet it affects 20–40% of women with chronic pelvic pain. In pelvic venous insufficiency, it results from impaired circulation in the erectile tissues of the clitoris and vagina. Excessive congestion and pelvic floor muscle contractions during orgasm can cause pain lasting several minutes, and in extreme cases, even a few hours.

Are you experiencing any of the symptoms listed? What should you do if you recognize the 5D Syndrome in yourself? the 5D Syndrome?

The initial step involves identifying a specialist who will take the patient’s symptoms seriously and possesses expertise in this domain. As is well known, this presents a significant challenge in Poland and beyond. The diagnosis of pelvic venous insufficiency and endometriosis necessitates a holistic approach, incorporating specialized ultrasonographic assessments (comprehensive evaluation of the venous system via Doppler ultrasound) as well as imaging modalities such as CT venography, MR venography, and, less frequently, IVUS or digital phlebography. At the Phlebology Clinic, I have been engaged in this field for over 15 years. a medical team radiologists, phlebologists, interventional radiologists and, in selected cases, vascular surgeons and gynecologists cooperating with our team (who are also familiar with pelvic venous insufficiency, in addition to endometriosis).

The positive aspect is that, in contemporary practice, we are frequently able to treat our patients—particularly those with pelvic venous insufficiency—or substantially alleviate the symptoms of the 5D SyndromeIt is important that the correct diagnosis is made as early as possible. Definitely the most difficult to treat are patients presenting with concomitant pelvic venous insufficiency (PVI) and endometriosis, in whom spread of endometrial tissue.

It should be noted that symptoms of pelvic venous insufficiency can appear as early as the first menstruation (endometriosis at this age is much less common). Pregnancy consistently acts as a factor that exacerbates or may even initiate the manifestations of venous disease. Therefore, a skilled approach and the appropriate expertise of the managing gynecologist are crucial Endometriosis similar to pelvic venous insufficiency, necessitates a personalized approach encompassing dietary management, anti-inflammatory therapy, hormonal treatment, and, ultimately, surgical intervention, which is frequently the sole effective option.

For women exhibiting 5D Syndrome symptoms objawy zespołu 5Din whom both pelvic venous insufficiency and endometriosis are diagnosed, the sequence and coordination of therapeutic interventions are of paramount importance Hence, collaboration between the phlebologist and gynecologist is essential – !!

Do not wait for a miracle—consult a phlebologist. flebologa!

The 5D Syndrome is not a figment of imagination or ‘women’s whims.’ These are real symptoms of actual diseases that significantly reduce a woman’s quality of life at any age, potentially leading to anemia, depression, and serious life challenges. If you recognize even two or three of the described symptoms or complaints in yourself, don’t wait for it to ‘just go away.’ Don’t believe that ‘this is just how it is’—because you are a woman!

(!) Remember: knowledge is the first step toward health. Share this article with a friend who might need this information. Sometimes a single conversation or a read article can change someone’s life.