Gonadal vein insufficiency is a varicose dilatation of the veins draining from tesicles and ovaries. Besides these, many other veins that drain other pelvic organs are frequently affected. The dilatation mainly occurs due to lack of or inssufficience of venous valves. This condition has been known for centuries as varicocele in men, but today it is also being recognised in women as pelvic congestion syndrome. The main reason for this lies in the clinical presentation of the illnes itself and the diagnostic methods used. Unlike varicocele, which is often visible and easily diagnosed by inspection and palpation, pelvic congestion syndrome is chatacterised by nonspecific symptomes such as chronic pain and is therefore considered only after exclusion of every other possible cause. Traditionally used in diagnosing pelvic vein congestion is venography, which can also be used as a therapeutic procedure. Throughout history the treatement method of choice was surgery. Today, due to the implemetation of new approaches, mainly endovascular, insufficiency treatement has become more succesful, with minnimal complications. It is important to approach the patient individually, and to chose the most suitable method.