Acute abdomen is a frequent clinical picture in emergency diagnostics. Pathologic changes of the female genital organs play an important role. Gynecologic emergencies threaten fertility and are potentially life-threatening. Many differential diagnoses must be considered in the diagnostic process, depending on the age of the patient and any pregnancy. In particular, acute gastrointestinal symptoms often cannot be differentiated from gynecologic emergencies on clinical examination. Here, imaging makes a significant contribution to narrowing the differential diagnosis, making treatment decisions, and monitoring therapy. This review article will discuss the central role of imaging in the context of common gynecologic emergencies.