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! >>
Once again, THANKS FOR READING!
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