Aim: We review clinical characteristics, diagnostic difficulties, and our experience in the surgical management of ovarian fibromas. Method: Twenty-three women with the operative diagnosis of an ovarian fibroma managed between January 1995 and August 2004 were reviewed retrospectively. Results: These patients comprised 1% of all benign ovarian tumors seen over this study period. The median age was 45 years, and 11 patients (47.8%) were postmenopausal. The main presenting symptom was abdominal pain (43.5%). The diagnosis of an ovarian fibroma or a solid ovarian tumor was correctly made preoperatively in only 5 patients (21.7%). All patients underwent surgical treatment: 18 by laparotomy and 5 by laparoscopy. All tumors were unilateral, and the median size was 13 cm. Fourteen patients underwent conservative surgery, and 9 had total abdominal hysterectomy with bilateral salpingo-oophorectomy. Two cases of fibrosarcoma were reviewed on the final pathology. Conclusions: Gynecologists should be aware of this group of ovarian tumors despite their uncommon occurrence. There are clinical clues to differentiate an ovarian fibroma from uterine fibroid and ovarian malignancy. Surgical removal of these solid ovarian tumors is recommended because of the low probability of malignancy. Minimal-access surgery is an option, especially when the tumor is of moderate or small size.