Vulvar and vaginal lesions representing a wide spectrum of diseases in female lower genital tract diseases make up a small part of all gynecological etiologies. Many of them are rare etiologies and are reported in case-reports studies. Translabial and transperineal ultrasound are modalities of choice for the first evaluation of perineal lesions. MRI is usually performed to determine the etiology of the lesions and stage. Benign lesions of the vulva and vagina usually manifest as simple cystic (vestibular cyst or endometrioma) or solid lesions (leiomyoma or angiofibroblastoma), while malignancies usually appear as large, solid masses and fill into both vaginal and perineal area. Post-contrast images play an important role in establishing a differential diagnosis, however, some benign lesions can also exhibit a vivid enhancement. Knowledge about radiologic-associated pathological manifestations may aid clinicians in better understanding these pathologies, especially for some rare lesions, and making a proper diagnosis before invasive procedures.