Key content Pelvic congestion syndrome is a poorly understood condition that forms part of chronic pelvic pain syndrome – this makes up 10–40% of gynaecological outpatient department referrals. Pelvic congestion syndrome is thought to affect 3.8% of women of childbearing age yet the clinicians evaluating these patients are usually unaware of the condition and a significant number of trainees are not up to date with the current diagnostic and management options. Learning objectives To learn about the pathophysiology and the risk factors. To learn to recognise the condition. To be able to discuss various management options and choose a definitive mode of treatment tailored to individual need. Ethical issues Are we doing justice to patients if we as clinicians are not actually aware of this common and significant condition? Due to current gynaecological investigations not being able to diagnose this condition and general unawareness of the current available diagnostic tests, should we not be more aware of all the investigative modalities and the most appropriate ones for our patients so that a more definitive diagnosis can be made?