Transvaginal sonography (TVS) was introduced into clinical practice in 1983 and first reported in the English literature in 1984. Since these early reports, TVS has become an integral part of gynecological practice worldwide. It is an intimate examination and considered by many as an invasive procedure. Hence, it is essential that practitioners who embark on a career where TVS is used routinely be familiar with the techniques and factors that may adversely impact and equally enhance the overall patient experience. This chapter is divided into two sections: section 1 addresses the basic principles of anatomical and scanning planes; ultrasound appearance of pelvic anatomy; patient-related skills and overall experience; image acquisition, optimization, and interpretation; systematic approach to the examination techniques; general scanning conventions; and discipline-specific professional skills. Section 2 covers the following topics: the basic principles of sound, the generation of ultrasound, the interactions of ultrasound with tissue, real-time B-mode imaging, the basic principles of Doppler ultrasound, machine controls and image optimization, and finally, the safety of ultrasound.