This chapter outlines the pivotal role of ultrasound in evaluating gynecologic conditions that compromise reproductive health. Congenital uterine anomalies (e.g., septate or bicornuate uteri) and vaginal developmental disorders are systematically characterized through standardized imaging protocols. Common uterine pathologies—including endometrial polyps, fibroids, and adenomyosis—are differentiated using transvaginal ultrasound with Doppler to assess structural and vascular features. Ovarian conditions such as endometriomas, benign cysts, and neoplasms are identified based on morphological patterns and blood flow profiles. Tubal abnormalities (e.g., hydrosalpinx) and paratubal lesions are distinguished from ovarian masses through multiplanar imaging. By integrating real-time anatomical and hemodynamic data, ultrasound enables early detection, accurate differential diagnosis, and longitudinal monitoring of these disorders. This noninvasive approach directly informs critical clinical decisions, from fertility preservation strategies to surgical planning, ultimately enhancing patient outcomes in reproductive medicine.