Background: Recently, transvaginal color Doppler ultrasound (TVCDU) has been widely used in the diagnosis of pelvic tumors. This study aimed to assess the reliability of the application of TVCDU in the identification of pelvic tumors in women of childbearing age. Methods:The clinical data of 209 patients with pelvic tumors at childbearing age admitted to our hospital from January 2016 to December 2019 were retrospectively analyzed. The ultrasound signs, color Doppler ultrasound score (CDUS), and resistance index (RI) of benign and malignant pelvic tumors diagnosed by TVCDU were analyzed. The value of transabdominal color Doppler ultrasound (TACDU) and TVCDU in the diagnosis of benign and malignant pelvic tumors was calculated.Results: There were 150 cases with benign pelvic tumors and 59 cases with malignant tumors. Most benign tumors had an intact capsule and regular shape, were mainly cystic, and were rarely accompanied by ascites; meanwhile, malignant tumors were mostly non-capsular and irregular in shape, mainly solid or cystic, and were often accompanied by ascites. There were significant differences in the above-mentioned ultrasound signs between benign and malignant tumors (P<0.05). The CDUS score of benign pelvic tumors was significantly lower than that of malignant tumors, and the RI value was significantly higher than that of the malignant tumors (P<0.05). The sensitivity, specificity, and accuracy of TACDU in the diagnosis of benign pelvic and malignant tumors were 83.33%, 84.75%, and 83.73%, respectively; and the sensitivity, specificity, and the accuracy of TVCDU in the diagnosis of benign pelvic and malignant tumors were 95.33%, 88.14%, and 93.30%, respectively; thus TVCDU had a superior performance compared to TACDU, especially in sensitivity and accuracy (P<0.05). Conclusions:The sensitivity and accuracy of TVCDU in the differential diagnosis of benign pelvic and malignant tumors in women at childbearing age were significantly higher than those of TACDU. The combined application of CDUS and RI can further improve the accuracy in the diagnosis of pelvic tumors.