In most practices, sonohysterography is immediately preceded by high-frequency transvaginal sonography (TVS). Exact menstrual dating and latex allergy are documented first, and a negative pregnancy test is obtained, along with a signed informed consent, when appropriate. The purpose of the baseline ultrasound is to confirm all pelvic findings prior to the fluid enhancement study. Although sonohysterography provides an indirect look inside the uterus, its ability to accurately diagnose intracavitary filling defects, such as myomas and polyps and adhesions and even malformations, matches that of the gold standard hysteroscopy. This chapter lists out specific imaging examples for submucous myoma, endometrial polyp, blood clot, endometrial malignancy, intrauterine synechia and congenital uterine anomaly. It outlines three-dimensional saline infusion sonohysterography (SIS), sonosalpingography or hysterosalpingo-contrast sonography, operative SIS, and sonovaginography. Combining TVS with vaginal saline infusion may improve the ability to image structures surrounding the vagina, such as the rectovaginal septum for endometriosis.