Paraurethral and paravaginal lesions are uncommon entities that often present diagnostic challenges due to their anatomical complexity, varied etiologies, and overlapping clinical presentations. Accurate identification and characterization of these lesions are essential for appropriate management and surgical planning. A structured diagnostic approach, based on clinical history, lesion location, and imaging features, is critical to avoid misdiagnosis and unnecessary interventions. Magnetic resonance imaging (MRI) has emerged as the modality of choice due to its excellent soft-tissue contrast, multiplanar capabilities, and non-invasive nature, offering superior delineation of lesion extent and relationship with adjacent pelvic structures. This pictorial review seeks to support radiologists and clinicians by offering a comprehensive yet practical guide to the imaging evaluation of paraurethral and paravaginal lesions. Through high-resolution MRI images and original anatomical illustrations, we aim to reduce the gap between imaging interpretation and clinical decision-making. We summarize the primary MRI indications for evaluating female urethral pathology, provide an overview of common and rare differential diagnoses, and highlight relevant MRI protocol considerations. Additionally, we include correlations with surgical findings when available, to enhance clinical applicability. Rather than providing an exhaustive catalog of entities, our focus is to promote standardized imaging assessment and highlight key anatomical and diagnostic considerations that may facilitate a more confident and informed multidisciplinary approach to these often-overlooked pelvic pathologies.