Posted on May 30th, 2017 by
transvaginal ultrasound, endovaginal, TV probe

TV Probe

Transvaginal Ultrasound ~
You’re Gonna Put What WHERE?!

I always know that face…the one with the saucer-like eyes and mouth gaping open in utter shock as soon as I speak the words “transvaginal ultrasound.” I point to the probe sitting so innocently on my machine. Poor thing…it gets such scathing rejection and so little credit!

I can’t really blame the patient. After all, a gynecological scan isn’t exactly something people volunteer for (unlike the OB ones – at least they have something cute to ogle!). I can’t tell you HOW MANY times patients have said, “Boy, these are more fun when there’s a baby in there.” A dollar for every one of those comments and I’d have a penthouse in Manhattan by now.

Most patients still in the baby-making stages of life are typically pretty familiar with a transvaginal ultrasound. It’s how we see Baby early in the first trimester or monitor the cervix. But many young or older women are not familiar with my long skinny friend. Some are mortified at the thought of this exam. To note, these patients are always there because of a problem which could be a whole myriad of issues from crazy periods to ovarian cysts.

The Transvaginal Ultrasound Protocol

One thing is for sure. Give me a woman with pelvic pain and, I can promise you, the last thing she wants to see is any ferociously-long object headed down south. I first apologize then promise that it’s quick and painless. I also add that at least they didn’t have to drink a gallon of water and hold it. Okay, I’m over-exaggerating. Some facilities still require patients to drink approximately 32 ozs of fluid for a transabdominal pelvic ultrasound (a scan on top the belly). You can read more about bladder preps here: How Much Water to Drink for Your Ultrasound

This little fact is usually enough to get a deliberately labored, “Okaaaaaay, what do I have to do now?” But it’s still a consent! Goal.

Transvaginal Ultrasound Provides You a Better Exam!

Vaginal ultrasound is probably, to me anyway, THE best ultrasound invention since ultrasound’s inception. I tell patients it really is the difference between night and day. It’s much like looking out of a clear glass window versus one with a sheer curtain drawn. I would say that about 95% of the time, I can see better when using the vaginal approach. A very large uterus or pelvic mass, however, would require an abdominal approach.

Did you just say you want a little Ultrasound Physics 101?? Well, I thought so! I’ll make it short. The transvaginal probe is built to deliver a higher-frequency sound wave which doesn’t penetrate very deep into the body. It offers by far the BEST resolution because the uterus and ovaries lie close to the probe. When we scan over the pelvis with a full bladder, the fluid provides a window for the uterus and ovaries behind it. However, by the time the sound waves get all the way down to those organs and back, we have a somewhat compromised image. The vaginal probe requires an empty bladder which allows us to see the uterus better.

We cover the probe with a condom or glove and insert it into the vaginal canal like a tampon. Be sure to let your sonographer know if you have a latex allergy! We place the probe against the cervix only; it does NOT enter into the uterus. The cervix remains closed (unless you’re in labor), so it cannot be inserted past this point. The sonographer obtains a magnified image of the uterus and ovaries and the areas immediately around them. We measure the uterus, endometrium (lining of the uterus), ovaries, and any pathology that we see related to those organs. Air and gas are not our friends, so sometimes those factors interfere with a good image.

How Long Does a Transvaginal Ultrasound Take?

About fifteen minutes, longer if the exam is complicated by pathology or if views we need are difficult to obtain. (By the way, “pathology” doesn’t always mean a worrisome or dangerous process!) When it’s over, the patient usually says the exam wasn’t that bad at all! Frequently, they will share the reason for their trepidation. It’s mostly because a friend had one done by a technologist with a heavy hand, making it quite a painful experience. I’ll usually respond by saying, “Firstly, you should ALWAYS tell someone when your exam is that painful. And, secondly, we don’t need to see your tonsils!” I’m not a comedienne, but that comment usually gets a much-needed laugh, and the end of the scan is very much appreciated:)


More coming about transvaginal ultrasound and your early OB scans with the release of my new book about first-trimester ultrasound. Hopefully, very soon! You can receive automatic updates on the book (along with a little something special when it publishes!) and the most current posts by subscribing to my blog. You’ll see where in the right margin! >>


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Posted on December 5th, 2015 by

Two of the most feared words in any woman’s vocabulary..

ovarian cancer

Most people think of ultrasound as relative to OB and cute baby pics but every one of us humans walking the earth are only here via a once-inhabited uterus. That said, the specialty is nothing without the study of the non-gravid uterus, as well, thereby forever tying it together with Gynecology.

A large part of my career is dedicated to the fetus-free uterus and her companion ovaries. Call me crazy but it’s actually a nice departure from scanning many back-to-back uncooperative babies. A complicated pelvic scan can, however, be every bit as challenging as the moving target of an active fetus. Combine a difficult tilt to the uterus and multiple fibroids (muscular tumors) with moving intestines and lots of other pathology and, suddenly, babies are decidedly a little more fun to scan.

The hardest part of scanning babies is obvious. The occasional miscarriage and abnormality can be devastating. But another kind of trauma is finding the incidental ovarian mass with features that leave our suspicions high for cancer; a large cystic or solid tumor with septations and vascularity are a few.  Though we can never be tissue specific with our suspected diagnosis, I know when I am imaging and measuring this mass that the outcome is likely not good.

My heart immediately sinks and I feel an overwhelming sadness for this patient, especially at this time of year. Instead of enjoying the holidays with her family during what is a happy and celebratory time for most, I can’t help but think of what she must be feeling. I imagine she may have broken down in tears as she left the office. I wonder, just as I’m putting my head to pillow, if she is doing the same and praying tearful prayers. I imagine her having to break the news to her family who will lose sleep with worry that their mother, wife or sister may not be with them for next year’s Thanksgiving feast or Christmas dinner. I wonder if she is overwhelmed this season with too much information she doesn’t understand, unending tests and thoughts of all she’ll have to endure over the coming months..painful surgery, radiation and chemotherapy. I ask myself if she even has that much time. She’ll know very soon.

I ponder this stuff because I imagine this is the personal roller coaster I would be riding. But I write this not to be a downer, but to give cause for some inspiration. This IS the season for inspiration, right? Sometimes, it’s these very people who have been presented with just such a challenge that seem to be the strongest people we know. They have fight and positivity and realize their priorities. They know how to value what is important.  Too often we are way to busy to do the same.

So, if this isn’t the season for spiritual strengthening, faith, family and celebration of our time together, I don’t know what is. These little gifts can be something we put in our own stocking this year, right next to that cute little bundle Santa just delivered.  Merry Christmas and enjoy those you love this holiday!

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Posted on June 23rd, 2015 by

Transvaginal ultrasound provides THE best contribution to ultrasound, bar none. It gives us a high resolution image because the probe lies closer to the organs and utilizes a higher frequency than abdominal probes. Most women come alone; some need the support of a spouse; some need the whole family!

Case in point. A young patient comes into the office with an entourage. I needed to check my memory twice, reminding myself that she wasn’t there for an OB appointment. With her was her mom, her child, and her boyfriend. Mom insisted on coming in for the exam along with the child. Of course, I could care less as long as the patient wants them in there. I have to ask all the same questions regardless of who else is in the room. If you don’t want someone hearing all your personal GYN business, you’d better have them wait outside. This wasn’t the case here on this day; nonetheless, no truer statement has ever been spoken…well, typed, that is.

Transvaginal Ultrasound is Not Always a Welcomed Approach!

About 80% of the time, I get the same reaction. I say the word “transvaginal,” and I see my patients’ eyes get as big as dinner plates. I realize the hesitation on several points. If you’ve never heard of it, if you’ve never had one done, or if you’ve never been to the GYN doc, I condone “the look.”

transvaginal probe

Honestly, I’d do the same if someone came at me with one of these sans my ultrasound education. Wouldn’t you?

If someone has had no sexual experience or if a patient has had a bad personal experience in the past which has left them emotionally scarred, the hesitation is understandable. Usually, I know about these well in advance. We plan around them by having the patient fill her bladder or by simply explaining the exam and allowing her the choice.

The examination almost always causes a bit awkwardness for the patient (though never for me). We always recommend the support of a spouse or friend if the patient feels anxious about the exam or results. Otherwise, a targeted visit for Marble Slab should immediately follow. Isn’t that the sole purpose for ice cream anyway? I think it would make for an interesting new ad campaign. Ice cream…the perfect post-stirrup consolation prize!

Thanks for reading and have a great day!

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Posted on November 24th, 2014 by

Ultrasound’s job is to find pathology, aka disease. More pathology means more time dedicated to each patient’s examination and reporting.

I cannot remember a time when I’ve seen two cases of cancer in one week…one ovarian and the other was a suspected fallopian tube cancer which is very rare. Either way, it is always a bit dis-heartening to see a mass in the pelvis with concerning size or features.  Sometimes we take one look and just know it is something bad for this patient.  It’s hard for me knowing I have to put a smile on my face and show this patient out the door. I think about how her life will be changed and what she will have to face in the upcoming months. I think about her family and how they must feel upon hearing the news and then facing the repercussions with her.

The only thing that makes me feel a little better is knowing it was caught but feeling a little sad the patient didn’t come in sooner.  We all do it.  We put off symptoms thinking they’ll go away or it’s nothing.  We can’t ignore the things our bodies are trying to tell us.  The best we can do is to address it sooner than later and hope it turns out to be nothing. If nothing is really something, maybe something can be done to treat you now vs having few choices later.

I have thought of those two ladies many times.  I keep checking their charts and with their doctors to follow-up for news.  I have kept them in my prayers.  It makes me a little sad to think of how their holiday might be changed for the worse.  Alternatively, it’s also quite surprising how such news can also be a Pandora’s box of unexpected blessings and thankfulness.  I wish them much of both.


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Posted on August 9th, 2014 by

Are we ever too old for ultrasound?  Do we ever get to an age where we won’t ever have a need for a pelvic ultrasound exam?  ..Never.

Working for obstetricians means they also manage their patients before and after they have babies which means that not only do I scan many babies but I also perform diagnostic ultrasound on a number of baby-free uteri and accompanying ovaries.  Moreover, my 70-80 year old patients have never even fathomed vaginal imaging.  Unfortunately, we ladies have female issues long before and long after our babies come along..everything from pelvic pain to ovarian cysts to abnormal periods to postmenopausal bleeding. I have heard more than once that they “NEVER thought they’d be doing THIS again”.  I wish I had a dollar for every time I’ve heard this in my career.  I’d probably be in Costa Rica somewhere sipping on a little umbrella drink with my toes in the sand.

My response to them is always the long as you are a woman and your heart is beating, you will ALWAYS have to put your feet in stirrups. We will never ever be too old for ultrasound, a pelvic exam or those awkward metal foot holders. Believe me, it’s not my favorite way to spend 30 minutes, either.  Feet here and slide on down to the end, Ladies!

I’m coming back in my next life as a man.

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Posted on April 13th, 2014 by

There exists a whole plethora of reasons to do an ultrasound on the female pelvis before and after a little bun is baking in the oven. I know, I know, it’s not as much fun to talk about those “other” things but they are just as important as Baby. So today’s post is dedicated to the under-appreciated empty uterus.

Our bodies are amazing pieces of fleshy technology! We are a well-oiled machine, my friend, and the same holds true for GYN parts. The uterus bleeds like crazy in attempt to remove things that shouldn’t be there or will make us sick and the ovaries produce a cyst and ovulate (release the egg) every single month (for most women). The lining of our uterus gets thick every month JUST IN CASE a baby might want to implant there and if not, sheds with a period. Again, this is if your parts are functioning like clock-work.  When they aren’t, my docs come to the rescue. See, they are not just baby catchers!

Many symptoms warrant your gynecologist to order a pelvic ultrasound. Abnormal bleeding of any kind at any age is a good place to start..too much bleeding, not enough bleeding, no bleeding, bleeding between periods, painful periods (are any of them pleasant?) and bleeding after menopause are a few of the most common reasons.  Periods are no fun and having one for a month is certainly no celebration!  Pelvic pain or discomfort, bloating or something felt by your doctor during a pelvic exam are other very routine causes for ordering this exam.  Maybe something was diagnosed by a previous ultrasound or CT (CAT scan) and a follow-up was ordered to see if it is resolved.  If you have a family history of some GYN disease, this is yet another indication for ultrasound.  There are certainly many more which is why there are volumes dedicated to the subject in med school.

If one is ordered for you, check with your doctor regarding prep.  Sometimes you have to drink a ton of water for an abdominal scan, most often you don’t in which case this would be a transvaginal ultrasound.  It may sound terrible but it’s not, especially if you are sexually active.  If this is the case (let me think of a politically correct way to say this), the probe is much skinnier than, hopefully, anything that has been introduced to you before.  There.  How was that??  I didn’t say exactly what I wanted here but you get the point.   In other words, if you can manage one, the other will not be a problem!

Here is a link to one of my favorite early posts on the subject of transvaginal exams (you may have to copy and paste the link).  Enjoy!

And since not many people really want to see an image of a uterus or ovary, I’ll attach one of a very cute baby instead!


And what a precious little angel this one is!


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