Transvaginal Ultrasound

Author: Dr Monica Pahuja*

What is a transvaginal ultrasound?

Ultrasound is the term used for high-frequency soundwaves. Ultrasound examinations use these sound waves to produce a picture or image onto a screen showing the inside of your body. An ultrasound is carried out by a trained health professional (sonographer, radiologist or sonologist).

Transvaginal ultrasound is an examination of the female pelvis. It helps to see if there is any abnormality in the uterus (womb), cervix (the neck of the womb), endometrium (lining of the womb), fallopian tubes, ovaries, bladder or the pelvic cavity. It looks at the pelvic organs from inside the vagina using a special smooth, thin, handheld device called a transducer. This differs from an abdominal ultrasound, which uses a warm water-based clear gel applied to the skin of the abdomen and the transducer is moved gently across the pelvic area.

All ultrasound transducers transmit high-frequency sound waves, and these are reflected from different soft tissue, structures or parts in the body in different ways. These sound waves are converted to electrical impulses that produce a moving image on a screen.

An ultrasound has many advantages. It is painless and does not involve radiation, which means it is very safe. There are no injections, unless your doctor has specifically requested one. The high-frequency sound waves ensure images show very high detail, capable of looking at the very tiniest parts of the body. A health professional will be there with you, and you have the opportunity to communicate any concerns you have.

Why would my doctor refer me to have this procedure?

The test is requested by your doctor if you have symptoms of pelvic pain or abnormal bleeding, or to check for fibroids (muscle tumours of the uterus), polyps (areas of thickening of the lining of the uterus), ovarian cysts or tumours, infertility, or assessment of early pregnancy. It often follows an abdominal ultrasound scan using a smooth handheld transducer on the outside of the body, on the lower part of the abdomen (tummy).
A transvaginal ultrasound provides much more detailed pictures of the organs in the pelvis, particularly the uterus (including fallopian tubes and ovaries), when compared to ultrasound scanning of the pelvis from the lower abdomen.

How do I prepare for a transvaginal ultrasound?

No preparation is required. You will be asked to go to the toilet and empty your bladder before the test being carried out.

If you are having a period, the examination can still be carried out and it is often an advantage when assessing some gynaecological problems. If you are wearing a tampon, it will need to be removed.

A transvaginal ultrasound is a personally invasive examination, so before having the test you might be asked to sign a consent form. At all times, a patient’s dignity and privacy is protected during the examination.

The examination is carried out by sonographers who may be male or female. On arrival at the radiology facility, you should inform reception staff if you are not comfortable with a male sonographer and request a female sonographer carry out the examination. If a female sonographer is not available, then your appointment might have to be rescheduled.

If you do not object to a male sonographer, staff at the radiology facility will arrange for a female health worker to act as a chaperone (i.e. someone to accompany and support you during the examination; see Chaperone – InsideRadiology: About Radiology: General information).

If you feel uncomfortable or embarrassed at the thought of the test, you can request a chaperone be present whether a male or female sonographer is to carry out the examination. You can also request a family member be present.

If you decide you do not wish to have a transvaginal ultrasound, you should inform the reception staff at the radiology facility and can request an abdominal ultrasound instead. If you have an abdominal ultrasound, you will need to drink two to three glasses of water 30 minutes before your test so that you have a full bladder.

It is a good idea to wear comfortable clothing that gives easy access to the lower part of your body.

What happens during a transvaginal ultrasound?

After emptying your bladder, you will be asked to undress from the waist down and you might be asked to wear a gown. You will then be asked to lie on an examination bed. Generally, a sheet is provided to cover you. You will be asked to bend your legs and the special transducer is inserted into the vagina. The transducer is slightly larger than a tampon and especially shaped to fit comfortably into the vagina. A protective cover is placed over the transducer and warm lubricating gel is applied to it for ease of insertion. It is gently moved around the inside of the pelvis and images are taken. You might have your lower abdomen pushed with the examiners hand to try and get some of the pelvic organs closer to the transducer for better pictures.

The examination is carried out in “real time”, which means that the images you see on the screen show the inside of your pelvic (lower abdomen) area. Still photographs are also taken during the examination.

At the end of the test, the probe is fully sterilized and cleaned.

Are there any after effects of a transvaginal ultrasound?

There are no after effects of a transvaginal ultrasound. You will be able to resume normal activities. You may notice some slight vaginal discharge from the lubrication gel after the test, but this should stop within 24 hours.

How long does a transvaginal ultrasound take?

The examination takes between 15–30 minutes.

Sometimes you will be asked to wait and have the images checked by the radiologist or obstetrician sonologist (specialist doctors). The sonographer, the health professional who carries out the ultrasound examination, might ask the doctor to come into the room and check what has been seen. Usually the doctor will let you know what they have seen and if there are any concerns.

In some facilities, the doctor or specialist will carry out the examination and will usually inform you of the findings.

What are the risks of a transvaginal ultrasound?

There are no known risks of having transvaginal ultrasound. It uses sound waves to obtain images and there is no radiation involved.

If you are pregnant, there are no risks to the foetus (unborn baby). If you are pregnant and your waters have broken, but you are not in labour (this is called premature rupture of the membranes), it is not advisable to have an ultrasound due to a small increase in the risk of infection to your unborn baby.
If you are pregnant and known to have an abnormally low-lying placenta (called placenta praevia) and you are experiencing vaginal bleeding, it is not advised to have transvaginal ultrasound, as it could make the bleeding worse.

What are the benefits of a transvaginal ultrasound?

The insertion of the transducer into the vagina allows a very close and clear view of the pelvic organs, and very clear ultrasound images to be taken of the area. This will help to guide the discussion between you and your doctor about any further investigation or treatment that might be needed.

Who does the transvaginal ultrasound?

The examination is carried out by sonographers, who are health professionals specially trained and accredited to do the test.

The sonographer might leave the room to show the pictures to the reporting doctor, who might come in and scan again if something needs to be checked. A full report of the scan will be written and sent to your referring doctor.
At some hospitals or radiology facilities, an obstetrician sonologist or radiologist (specialist doctors) might do the examination. Other health professionals, usually a nurse, might also be in attendance.

Where is a transvaginal ultrasound done?

The examination is carried out in a radiology department of a hospital, private radiology practice or at a specialist clinic for obstetric and gynaecological imaging. The examination is carried out in the privacy of an ultrasound room, which might be dimly lit to allow the images on the ultrasound screen to be clearly seen. To maintain your privacy, the examination door is closed and there is a sign on the outside stating that an ultrasound examination is in progress.

When can I expect the results of my transvaginal ultrasound?

The time it takes for your doctor to receive a written report will vary. The private radiology practice, clinic or hospital where your procedure is carried out will be able to tell you when your doctor is likely to receive the report.

It is important that you discuss the results with your doctor, either in person or on the telephone, so that they can explain what the results mean for you.

*The author has no conflict of interest with this topic.

Page last modified on 31/8/2017.