Transvaginal Ultrasound

Your doctor has requested that you have a pelvic ultrasound.  What can you expect?  Well, first of all, some of the reasons that you may get a pelvic ultrasound include:

An ultrasound is like any other medical imaging test.  It must be prescribed by your doctor.  You can’t go to an ultrasound department and request that they scan you.  There has to be a medical indication. 

When the ultrasound appointment has been scheduled, you will probably be told that you need to drink at least 32 ounces of water and not empty your bladder.  This is important because your uterus resides behind your bladder and when the technologist is scanning you from your abdomen, a full bladder is necessary to visualize your uterus and ovaries.

Once you have checked in at the ultrasound department, which is usually within the radiology department, you may be asked to complete some standard forms dealing with your medical history and insurance.

The technologist will come to the waiting room and call out your name, usually just your first name or last name.  By now you will probably need to empty your bladder, but your technologist is aware of your discomfort and will be as efficient as possible.

Once you are in the exam room you may be asked to remove everything below your waist and put on a backless hospital gown, or you may be asked to lie on your back on the exam table and lower your pants and underwear just a bit. 

The technologist will apply some warm ultrasound gel to the transducer and begin scanning your lower abdomen.  Please let the technologist know if he or she is pushing too hard. 

Ultrasound works by transmitting high frequency sound waves through the transducer.  The transducer then listens for those returning echoes coming from the tissues inside your body.  Ultrasound looks at soft tissue organs but is unable to evaluate intestines or bone.

The technologist will be taking images of your uterus and ovaries, measuring them, and making note of any abnormalities.

Normally there are two parts to having a pelvic ultrasound.  The first part is the abdominal scan which was just described.  The second part is called an endovaginal or transvaginal ultrasound.  A transvaginal ultrasound probe works the same way as the abdominal probe does but it’s long and thin.  It is generally a higher frequency probe which means that it generates images of a higher resolution and is closer to the uterus and ovaries once inserted into your vagina.  Think of the forest and the trees.  The abdominal scan looks at the forest giving an overall view of your pelvis.  The vaginal scan looks at the individual trees (uterus and ovaries) in greater detail.

If you haven’t been sexually active a vaginal ultrasound is not usually performed.

The vaginal ultrasound probe will be covered with a condom and will have been soaked in a disinfectant between uses. 

The good news is that you have to have an empty bladder for the vaginal ultrasound.  The technologist will ask you to use the bathroom and empty your bladder completely.  As important as it was that it be full for the abdominal part, it’s equally important that it be empty for the vaginal part.

If you’re having bleeding and are wearing a tampon, you will need to remove it.  If you’re bleeding heavily just let the technologist know that she an absorbent pad will be placed on the table for you.  Don’t be embarrassed.  Their only interest is trying to help your physician figure out what problems there might be.

Some ultrasound exam rooms have tables equipped with stirrups on the table.  The will be in place and you will be asked to put your feet in them and slide all the way down to the end of the table.  If the table doesn’t have stirrups, you may be asked to place a pillow or booster under your hips so that they are propped up. 

The technologist will insert the probe, or ask you to do it.  It isn’t painful and isn’t much bigger than a tampon.  The technologist will move the probe around taking pictures of your uterus and ovaries, measuring them, and documenting any abnormalities.  You may hear sounds similar to a heart beat.  The technologist is using Doppler ultrasound to demonstrate that there is normal blood flow in your ovaries.

After taking all the necessary pictures the technologist will remove the probe and remove the booster from under your hips or ask you to take your feet out of the stirrups and make yourself comfortable.

In many departments, the technologist will need to show the images to the radiologist who actually interprets the images.  You may be asked to wait while this is done to make sure that no more pictures are needed.  If there are questions, the technologist may need to take more images, or the radiologist may come in and either scan or watch the technologist scan.  Some departments allow the technologist to let the patient go if they are satisfied with the quality of the study.

An ultrasound technologist is a highly trained medical professional.  They are accredited by the American Registry of Diagnostic Medical Sonographers.  In order to be accredited they must have passed at least two very difficult registry exams.  In the past, many sonographers were trained on the job.  Today a technologist must go to an accredited ultrasound school which can be one to four years long.  One year programs are hospital based and require the applicant to have a medical background (often radiologic technology) and a college degree.  Two to four year programs grant associate degrees or bachelor degrees upon completion.  Look for RDMS after your technologist’s name on their name badge.  In order to pass the registry exams, the technologist has to know how to operate the ultrasound machine, know the anatomy they are scanning, and know the pathology of the organs they are scanning.  If your technologist doesn’t reveal the results of your scan to you, please understand that the department where they work may prohibit that or the technologist may not be familiar with your medical history to provide a complete answer.  Your physician knows all that and is the one who will provide you with the results and treatment.

This video is a graphic representation of a vaginal ultrasound.  It should only be viewed by those over 18.