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 June 28th, 2015 by

Today’s post is an extension of the last, expounding a little more on the technical details of the transvaginal ultrasound.  As I mentioned previously, this approach to the pelvic organs has been the most impressive addition to the modality and the best way to image these organs.

There is no prep for this exam unlike the dreaded filling of the bladder for the abdominal approach.  Moreover, an empty bladder is required since too much urine will cause the bladder to push the uterus too far back, yielding a limited image.

The exam typically takes me about 10-15 minutes in a normal exam.  Everyone’s organs are positioned a little differently so a challenging angle or needing to document a lot of pathology can certainly cause your exam to run longer.  The uterus tilted backwards, the ovaries too high in the pelvis and intestines in the wrong place all make for a difficult or limited examination.  The intestines, or bowel loops, contain air and gas through which sound waves cannot penetrate.  Therefore, bowel sitting on top of your ovary can obscure the view altogether.  Oftentimes I can push around a little to obtain a better view or I’ll look abdominally anyway in an effort to see something, anything I couldn’t internally.  If your uterus is REALLY large (as in the case of large fibroids), I’m going to scan you abdominally anyway.

We measure the uterus and ovaries and document any pathology we see.  Uterine fibroids (a very common tumor of the uterine muscle, endometrial polyps (like a skin tag in the lining of your uterus), ovarian cysts or masses and fluid in the fallopian tubes are just some of the processes we see on a regular basis.  The exams are typically ordered by your doctor if you are experiencing pelvic pain or pressure, if something is felt on your pelvic exam or if you describe any myriad of problems with your period.  There are volumes of other reasons to perform this exam but the above are some of the most common.  A regular misperception I have found with the general public is they don’t realize ovarian cysts can be functional..meaning this is what the ovary does normally every month when we ovulate.  A cyst forms, ruptures, the egg is released..voila!  Ovulation.  So many come in concerned that ovarian cysts is a disease.  More often than not, it’s just a normal finding.

There are no side effects of the exam and it shouldn’t hurt.  Sometimes, if you come in with pelvic pain already, the exam may feel a little uncomfortable.  Most people complain of pressure on the bladder.  If it’s painful, let your sonographer know!  Sometimes “newbies” push too hard, unbeknownst to them.

When my patients come in stressed out about the exam, fearful because it hurt the last time they had one done or exhibit a little trepidation, I always try to lighten the mood with the same line.  “No, worries.. I just have to find your ovaries, not your tonsils!”  I always get a laugh and a thank you out of that;)

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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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