High-resolution magnetic resonance (MR) imaging with pelvic phased-array and endoluminal coils provides information on vaginal abnormalities heretofore not available with other imaging modalities. Congenital anomalies of the vagina can result from disorders of lateral fusion of the descending müllerian ducts and ascending urogenital sinus, developmental absence of the müllerian ducts, or disorders of vertical fusion. In these conditions, MR imaging can depict the presence or absence of the vagina, cervix, and uterus and help determine whether these structures contain a septum or are duplicated or distended with blood. Gartner duct cysts and Bartholin gland cysts have the same signal intensity characteristics, but the former are located in the anterolateral aspect of the proximal third of the vagina and the latter are in the posterolateral portion of the lower vagina. Entero-, vesico-, and ureterovaginal fistulas result from obstetric and surgical trauma, radiation therapy, or inflammatory bowel disease. MR imaging has great potential for detection and characterization of these fistulas. MR imaging can be used to detect and stage primary and secondary vaginal tumors. However, neither signal intensity nor patterns of enhancement enable confident prediction of the histologic subtype of vaginal malignancy.