Pelvic congestion syndrome (PCS) is now a well-established common vascular pathology, impacting the lives of millions everywhere. It deserves more public and medical staff education and awareness. During the last 25 years, our team has been taking care of thousands of female cases and, more recently, hundreds of male cases. We will expose this polymorphic pathology by trying to simplify its complex anatomy, physiology, diagnosis, and treatment approaches.