This study was designed to ascertain whether endovaginal sonography, if used alone, would lead to an unfavourable outcome by missing or falsely diagnosing significant pelvic pathology. We reviewed the sonographic reports, sonograms and medical records of 305 patients who underwent endovaginal sonography as the only method of examination and compared the original sonographic diagnosis with follow up data. Clinical documentation was obtained in 241 women and surgical documentation in 64. In all but one patient, there was no evidence that the therapeutic outcome was adversely affected because an endovaginal sonogram was the only diagnostic approach utilised. We conclude that endovaginal sonography can safely be used as the primary method of examination of the pelvis in the majority of patients. In selected instances, abdominal sonography can be used as a complementary procedure, particularly when the entire pelvis cannot be visualised. © 1992 Informa UK Ltd All rights reserved: reproduction in whole or part not permitted.