Definition and Overview

Transvaginal imaging is an ultrasound test used to evaluate the female reproductive system from inside the vagina. Also referred to as endovaginal ultrasound, it is often performed if a woman is suffering from abnormal bleeding and pelvic pain or if polyps, fibroids, and ovarian cysts are suspected. It can also be done in an attempt to identify the cause of female infertility and assess early pregnancy.

Unlike other imaging tests, the procedure uses sound waves and not radiation to create images of the internal organs. Thus, it is safe for the patient or foetus (if the patient is pregnant). It provides better images and more information than traditional pelvic ultrasound because the probe can be positioned closer to the pelvic organs.

Transvaginal ultrasound is performed by sonographers, radiologists, and obstetric sonologists.

Who Should Undergo and Expected Results

A transvaginal ultrasound is used to:

  • Determine the cause of female infertility

  • Determine the cause of heavy and painful periods as well as postmenopausal bleeding

  • Diagnose or confirm ectopic pregnancy

  • Confirm if the patient has uterine fibroids or ovarian cysts

  • Ensure that the intrauterine device (IUD) has been placed properly

  • Investigate the cause of pelvic pain and pain during sexual intercourse

In pregnant women, the procedure is performed to:

  • Monitor the growth of foetus and listen to the baby’s heartbeat

  • Look for signs of abnormalities that can lead to premature delivery or miscarriage

  • Confirm an early pregnancy

  • Detect a possible miscarriage

  • Determine the source of bleeding

  • Diagnose placenta previa or placental abruption. Placenta previa is when the placenta is lying low and covering the cervix. Placental abruption, on the other hand, is when the placenta separates from the uterus before the baby is born.

The test may also be ordered if the results of previous abdominal or pelvic ultrasound suggest an abnormality and to diagnose pelvic infection, ovarian tumours, thickened uterine lining, and birth defects.

The results of the procedure can be immediately interpreted if it is performed by an obstetrician. Otherwise, a technician or a radiologist may send the results to the doctor, who will discuss the findings to the patient on her next appointment.

How is the Procedure Performed?

For the procedure, the patient is asked to remove her clothes from the waist down and put on a gown before lying down on her back with legs spread and knees bent. After covering the ultrasound wand with a condom and lubricating gel, the doctor will insert it into the vagina. Using sound waves, the probe will start to create pictures of the organs, which are immediately transmitted to a nearby monitor.

The procedure is not painful and is thus performed without the use of any anaesthetics. However, there may be some pressure, which many describe as tolerable. It is the same pressure felt during a pap smear when a speculum is inserted into the vagina to collect sample cells from the cervix.

Most patients do not usually need to prepare for the test. However, depending on the reason for the ultrasound, the doctor may need the patient’s bladder to be either partially full or totally empty. The doctor may require the patient to drink about 32 ounces of water prior to the procedure if he needs the intestine to be lifted so clearer pictures of the pelvic organs can be obtained.

If the test is performed to determine whether the endometrium has thickened or if there are polyps, the doctor may also perform saline infusion sonohysterography (SIS) in which a small volume of salt solution is inserted into the uterus so that it can be clearly seen on an ultrasound scan.

Most patients feel normal after the test and are able to resume normal activities right after. However, some experience pelvic discomfort and slight dizziness that commonly last for no more than a few minutes.

Possible Risks and Complications

Transvaginal ultrasound is a safe procedure for both patients and their unborn child (if the patient is pregnant). Aside from slight discomfort during and a couple of minutes after the test, there are no known risks or side effects.

In rare cases where patients are unable to tolerate the procedure, they may opt for a transabdominal ultrasound where the probe is pressed against the abdomen to view the pelvic organs.

References:

  • Transvaginal ultrasound. (n.d.). https://www.cedars-sinai.edu/Patients/Programs-and-Services/Imaging-Center/For-Patients/Exams-by-Procedure/Ultrasound/Transvaginal-Ultrasound.aspx

  • Transvaginal ultrasound: Diagnostics & testing. (2015). http://my.clevelandclinic.org/health/diagnostics/hic-abdominal-renal-ultrasound/hic-transvaginal-ultrasound

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