The governorate encompasses the south-easternmost coastal strip, totalling 9167 km² and had a population of 479,520 at the 2014 census.
The capital is Medenine
. The governorate includes the country's largest island, Djerba
, which is connected by bridge and has over a third of the total population of the governate and its own airport.
The area is generally lowlands. It extends in two projections at its extreme ends a maximum of 60 km from the coast, otherwise the neighbouring division of Tataouine
is 30 km from the coast. The northern projection abuts Kebili Governorate
and includes part of a long escarpment which extends from the south of Gabes Governorate (adjoining Medenine to the north) to beyond Tripoli in Libya and which is dotted with settlements. Precipitation is low and reaches a maximum between October and January, the far north of the governorate and western hill range benefiting from this most. Key settlements are those associated with ports, tourism, fishing, farming in more fertile parts within the north-east and oases.