In the evaluation of the female pelvis, sonography in general complements the physical examination of the patient. The goal is to differentiate normal features from pathophysiological lesions, inflammatory processes and tumoral masses, the latter ones either being benign or malignant. Transvaginal sonography is now generally considered as a more specific and more advanced diagnostic procedure than abdominal sonography. The ability to assess flow to and within the pelvic organs and masses using Doppler, expands the contribution of transvaginal ultrasound to the patho-physiologic parameters. The growth of new vessels or the development of existing ones forms a common thread throughout many areas of reproductive pathophysiology. Duplex transvaginal ultrasound will allow us to document some events in these areas. Since unrestricted tumor growth is dependent upon angiogenesis, transvaginal duplex ultrasound has thus been proposed to enhance the ultrasound specificity for gynecological cancer. However, similar processes of angiogenesis and thus Doppler features, can be observed during normal physiological events. To avoid confusion, morphological and Doppler features have to be carefully combined. This paper will emphasize on the relative contributions of each of them and the possible pitfalls.