Pelvic pain (acute or chronic) is a common symptom in women of all ages. Ultrasonography is the least invasive investigative tool available to the clinician. Transvaginal probes produce high-resolution images of the pelvic organs, providing reliable and reproducible information without the need for a full bladder. Common gynaecological pathology involving the uterus, Fallopian tube and/or the ovary can be diagnosed with confidence. Non-gynaecological pathology involving the bowel can also be diagnosed with accuracy, and will often be seen in the acute gynaecological setting. Ultrasound can be used to triage patients into appropriate treatment protocols, enabling the clinician to avoid surgery in some cases and select the correct surgical approach in others. If the patient has a negative pregnancy test, no pelvic tenderness on bimanual examination and a normal scan, significant pathology is very unlikely.