Pelvic congestion syndrome is another condition causing pelvic pain for which there is no consensus on diagnosis or treatment; moreover, some physicians don’t even believe it causes pelvic pain. Pain from pelvic congestion is multifactorial and may be caused by hypoxia and mechanical stretching of pelvic veins. It usually occurs after pregnancy (may be full term, ectopic, or miscarriage) and presents as a sensation of heaviness in the lower abdomen with upright body position. On the background of this sensation there is intermittent sharp lower pelvic pain. In our practice we diagnose pelvic pain based on symptoms but confirm it with transfundal venography preformed in the operating room immediately prior to surgery. We treat pelvic congestion syndrome either by referring the patient to interventional radiology for embolization of the pelvic veins or by surgical selective pelvic vein ligation. In this procedure we separate ovarian veins from arteries and legate them and then legate any significantly enlarged veins in the broad ligament. Outcomes from this treatment are effective; however, pain and congestion may return with time, especially if the patient becomes pregnant again.