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Transvaginal Ultrasound Scan: Everything You Need to Know

Knowledge Hub

8-12 mins readFact Checked
Author of post icon

Written By:

Atif Riaz

Medically Reviewed By:

Mr M. Usman

A typical transvaginal ultrasound transducer is a long wand-like probe that is used to assess a wide variety of gynaecology problems.

Introduction

What is ultrasound

Ultrasound is a common medical imaging test that is used to examine the internal organs and structures of the body. The procedure is usually performed by a specialist healthcare professional such as a sonographer.

In the NHS, an ultrasound scan must be prescribed by a doctor and there must be an imaging referral or medical indication for the test. However, in a private clinic such as The Scan Clinic, a referral is not required and you may self-refer for the scan. This could be done by contacting the clinic or booking the scan online.

What is a transvaginal ultrasound?

A transvaginal ultrasound is a medical procedure in which a small ultrasound probe is inserted into the vagina to produce images of the uterus, ovaries, and other pelvic organs. The procedure is typically performed by a trained healthcare professional, and it is often used as a diagnostic tool to evaluate various conditions related to the reproductive system.

The ultrasound probe is a wand-like device that emits high-frequency sound waves that bounce off internal structures and are captured by a computer to create detailed images. The procedure is non-invasive, which means that it does not involve any incisions or punctures, and it does not normally cause any significant pain or discomfort. The probe can appear big and daunting but usually, it is only a small part of it that is actually inserted into the vagina and may feel similar to a tampon. The procedure typically takes anywhere from 10 to 30 minutes to complete, and it is usually performed in a clinic, doctor’s office, or hospital.

A transvaginal ultrasound is more accurate for certain conditions, such as early pregnancy or for evaluating the uterus and ovaries because the probe is closer to the organs being examined.

Reasons for a transvaginal ultrasound scan

A transvaginal ultrasound is a medical imaging tool used as a tool to commonly assess and image the uterus, ovaries, and some other pelvic structures. Common reasons for a transvaginal scan include:

Pelvic pain

Pelvic pain is discomfort or pain felt in the lower abdomen, specifically in the area below the belly button and above the legs (pelvic area). It can range from a dull ache to a sharp pain and can be constant or come and go. Pelvic pain can be caused by a variety of medical conditions, including menstrual cramps, endometriosis, ovarian cysts, fibroids, urinary tract infections, and others. In some cases, the cause of pelvic pain may not be easily identified with a private ultrasound, and further diagnostic tests may be needed.

Irregular periods

Irregular periods refer to a menstrual cycle that is not consistent in either length or the amount and duration of bleeding. This can include cycles that are longer or shorter than the average of 28 days, or periods that are heavier or lighter than usual. Irregular periods can be caused by a variety of factors, including hormonal imbalances, stress, weight changes, polycystic ovary syndrome (PCOS), thyroid problems, and other conditions. In some cases, irregular periods may be a sign of a more serious underlying medical condition, and the scan is used to determine if an abnormality is present in your womb or ovaries.

Fibroids

Fibroids are benign (noncancerous) growths that develop in the uterus. They are made of smooth muscle and fibrous tissue and can vary in size from very small to several inches in diameter. Fibroids are very common and can affect up to 70% of women at some point in their life.

Some women may not experience any symptoms, while others may experience heavy bleeding, prolonged periods, pelvic pain, and pressure on the bladder or rectum, among others. In some cases, fibroids can also impact fertility. An ultrasound scan can help to determine the presence of fibroids and provide information about their size and position in order to help with treatment. The treatment for fibroids depends on the size, location, and symptoms and may include medication, uterine artery embolization, or surgery, such as a hysterectomy.

Abnormal vaginal bleeding

Abnormal vaginal bleeding refers to any bleeding that occurs outside of a woman’s normal menstrual cycle. This can include heavy or prolonged periods, spotting between periods, and bleeding after sexual intercourse, among others.

Abnormal vaginal bleeding can be caused by a variety of factors, including hormonal imbalances, uterine fibroids, polyps, endometrial or cervical cancer, pregnancy complications, and others. The scan can help identify some of these causes however in some cases, the cause of abnormal vaginal bleeding may not be easily identified, and further diagnostic tests may be needed.

Cysts on the ovary

Ovarian cysts are fluid-filled sacs that develop within or on the surface of the ovaries. They are common and can occur during the menstrual cycle as a result of the normal growth and release of eggs. Ovarian cysts can range in size from tiny to several inches in diameter and may cause no symptoms or only mild discomfort.

However, some women may experience pelvic pain, bloating, or discomfort during intercourse or bowel movements, among others. In some cases, ovarian cysts can become large, twist the ovary, or rupture, causing severe pain and potentially leading to internal bleeding.

Ovarian cysts can also impact fertility. A pelvic scan is often required to confirm or rule out ovarian cysts. The treatment for ovarian cysts depends on their size, symptoms, and type and may include observation, medication, or surgery, such as laparoscopy.

Polycystic Ovarian Syndrome

Polycystic ovary syndrome (PCOS) is a common hormonal disorder that affects women of reproductive age. It is characterised by the presence of multiple small cysts in the ovaries and an elevated level of male hormones called androgens that women also produce.

The exact cause of PCOS is not known, but it is believed to involve a combination of genetic, environmental, and lifestyle factors. Women with PCOS often experience irregular periods, heavy bleeding, acne, hirsutism (excess hair growth), and infertility. The condition can also increase the risk of certain medical problems, such as type 2 diabetes, heart disease, and endometrial cancer.

An ovarian scan can assess the ovaries and determine if the ovaries are polycystic, which can be a sign of PCOS. The treatment for PCOS depends on the symptoms and may include lifestyle changes, such as weight loss and exercise, as well as medications, such as the birth control pill, and others. It is important to consult a doctor for an accurate diagnosis and appropriate treatment.

Confirm Early Pregnancy

In early pregnancy, a transvaginal ultrasound is usually performed to produce clearer images of the uterus and look for the presence of a gestational sac and fetus.

These structures are extremely small at the early stages of pregnancy and may not be visible with an ‘over the tummy’ transabdominal scan, as they are too small. The gestational sac is the fluid-filled structure that surrounds the developing fetus. This gestational sac normally contains a yolk sac and a fetus, which is visible from around 5.5 – 6 weeks of the pregnancy.

The presence of these structures along with a positive pregnancy test confirms that a woman is pregnant. An ultrasound may also be used to measure the size of the gestational sac or fetus which can indicate your gestational age (how far along you are in the pregnancy).

Monitor Fetal Development

Ultrasound is commonly used to monitor fetal development during pregnancy. It provides real-time images of the fetus and helps healthcare providers assess fetal growth, anatomy, and well-being. Transabdominal ultrasound is typically performed during the first and second trimesters of pregnancy and uses a transducer placed on the mother’s abdomen to produce images of the fetus.

Transvaginal ultrasound is typically performed during early pregnancy when the fetus is still small and the gestational sac is located close to the cervix.

Ectopic Pregnancy

A transvaginal ultrasound is a commonly used tool to detect an ectopic pregnancy, which occurs when the fertilised egg implants outside the uterus, usually in the fallopian tubes. A transvaginal ultrasound will is typically prescribed as it produces clearer images of the uterus and surrounding structures.

The ultrasound may reveal the presence of a gestational sac or embryo in the fallopian tubes, rather than the uterus. The sonographer will also look for signs of fluid surrounding the gestational sac, which can indicate a ruptured ectopic pregnancy and an emergency medical situation.

It is important to note that an ectopic pregnancy can be very difficult to diagnose in its early stages, and a transvaginal ultrasound may not always detect it. Therefore, a combination of ultrasound and other tests, such as hCG blood tests may be needed to confirm a diagnosis of ectopic pregnancy.

If an ectopic pregnancy is suspected or diagnosed, prompt medical intervention is necessary to prevent serious health complications and preserve fertility.

Miscarriage

A transvaginal ultrasound is a commonly used tool to diagnose a miscarriage, which occurs when a pregnancy ends on its own before 20 weeks of gestation. The transvaginal ultrasound will provide clearer images for the pregnancy and may reveal the absence of a fetal heartbeat, or the absence of embryonic or fetal growth, indicating a non-viable pregnancy.

The healthcare provider will also look for signs of retained tissue or fluid in the uterus, which can indicate a complete or incomplete miscarriage. It is important to note that a transvaginal ultrasound may not always detect a very early miscarriage, and a combination of ultrasound and other tests, such as hCG blood tests, may be needed to confirm a diagnosis of miscarriage.

Cancer

A transvaginal ultrasound scan is a commonly used tool to help detect cancers of the female reproductive system, including endometrial, uterine and ovarian cancers. The ultrasound will check for abnormal growth or thickening of the endometrium or determine the presence of a cyst or solid mass in the ovary, which may indicate the presence of a tumour.

A transvaginal ultrasound is not however a diagnostic tool for cancer and may not always detect early-stage cancers. Therefore, a combination of ultrasound and other tests such as pelvic exams, and blood tests, may be needed to confirm a diagnosis of cancer.

Endometriosis

Endometriosis is a condition in which tissue similar to the lining of the uterus grows outside of the uterus, causing pain and fertility problems. A transvaginal ultrasound scan is a commonly used tool to help diagnose endometriosis as it can produce clearer images of the uterus, ovaries, and surrounding structures.

The scan is done in real-time and dynamic tests can be performed to check for signs of endometriosis. The healthcare provider will also look for signs of fluid buildup in the pelvis, which can indicate endometriosis-related adhesions or cysts.

It is important to note that a transvaginal ultrasound is not a definitive diagnostic tool for endometriosis, as the conditions can be difficult to detect on ultrasound alone and may not be visible. Therefore, a combination of ultrasound and other tests, such as laparoscopy and blood tests, may be needed to confirm a diagnosis of endometriosis.

Infertility

Infertility is the inability to conceive after one year of unprotected intercourse. A transvaginal ultrasound scan is a commonly used tool in the evaluation of infertility as it produces detailed images of the uterus, ovaries, and surrounding structures. The scan can check the structure and function of the reproductive organs, including the uterus, and ovaries, and in some specialist scans the fallopian tubes.

The healthcare provider will look for any abnormalities, such as uterine fibroids, polyps, or adhesions that could prevent conception or cause problems with pregnancy.

Ultrasound can also be used to monitor the growth and development of follicles, which are fluid-filled sacs in the ovaries that contain eggs. The size and number of follicles can help the healthcare provider determine if ovulation is occurring and assess the quality of the eggs.

The scan can be used to monitor the growth and development of the endometrial lining, which is the tissue that lines the uterus and prepares for the implantation of a fertilised egg. The thickness and appearance of the endometrial lining can help the healthcare provider determine if the uterine environment is suitable for implantation and pregnancy.

Contraceptive Coil

An intrauterine device (IUD), also known as a coil, is a contraceptive device inserted into the uterus to prevent pregnancy. A transvaginal ultrasound scan can be used to check the position of an intrauterine device (IUD) and ensure it is correctly positioned within the uterus. This is important, as the position of the IUD can impact its effectiveness in preventing pregnancy.

The ultrasound can also be used to check for any potential complications, such as perforation of the uterus, which occurs when the IUD punctures the wall of the uterus or migration of the IUD out of the uterus. These complications can be detected on ultrasound. Regular check-ups are important to ensure the IUD is functioning properly and monitor for potential complications.

Is a transvaginal ultrasound safe?

Transvaginal ultrasound is generally considered safe. It is a non-invasive procedure that does not involve any incisions or punctures and does not cause any pain or discomfort. It has minimal risks and side effects. The ultrasound probe emits high-frequency sound waves, which are not harmful to the body. The lubricating gel used during the procedure is also safe and does not cause any harm.

However, as with any medical procedure, there are some potential risks and complications to consider. In very rare cases, the procedure may cause mild discomfort or cramping. It’s also important to note that ultrasound energy can heat up tissue, but this effect is usually not significant enough to cause harm.

Overall, transvaginal ultrasound is a safe and effective diagnostic tool that can provide valuable information about the health of the reproductive system. It is widely used and has a good track record of safety. If you have any concerns, be sure to discuss them with your doctor before the procedure.

Can a transvaginal ultrasound cause a pregnancy loss or miscarriage?

In short no. Transvaginal ultrasound scanning is generally considered safe until a women’s water breaks. According to the Miscarriage Association, no evidence suggests that a transvaginal ultrasound can harm a fetus or result in pregnancy loss.

If a person experiences bleeding following a transvaginal ultrasound, it is likely due to blood collecting higher up in the vagina, possibly dislodged by the transducer.

Typically, transvaginal ultrasounds are performed during the first 11-12 weeks of pregnancy. After this period, transabdominal ultrasound is more commonly used. However, there are cases where a transvaginal ultrasound is still required as it can provide a more accurate and detailed view of either the baby or the internal structures.

When is the best time to perform a transvaginal ultrasound?

The best time to perform a transvaginal ultrasound can vary depending on the specific reason for the test. Some general guidelines include:

  • Pregnancy: Transvaginal ultrasound is often performed during the first trimester of pregnancy to confirm and monitor the pregnancy, and to determine the gestational age of the fetus. During this time, the ultrasound provides a clearer view of the uterus and the fetus than an external ultrasound.
  • Ovarian function: Transvaginal ultrasound is often performed during the early to mid-follicular phase of a woman’s menstrual cycle (around days 2-14) to assess the ovaries and the follicles (fluid-filled sacs that contain the eggs).
  • Endometrial thickening: Transvaginal ultrasound is often performed after a woman’s period has ended to evaluate the thickness of the endometrial lining, which can be an indicator of various conditions, including endometrial cancer.
  • Ovarian cysts: Transvaginal ultrasound can be performed at any time to evaluate ovarian cysts and to monitor their growth over time.

It’s important to discuss the specific reason for the test with your doctor or sonographer to determine the best time to perform the transvaginal ultrasound. Your doctor will take into account factors such as your menstrual cycle, pregnancy status, and any other relevant health conditions when determining the best time to perform the test.

Can a transvaginal ultrasound be performed during a period?

Yes, a transvaginal ultrasound can be performed during a woman’s menstrual period, although it may feel embarrassing. In general, however, the scan can be performed at any time of the cycle. However, sometimes the scan is required at a particular stage of the menstrual cycle or during a period to obtain the most accurate results.

In some instances, however, the results of the ultrasound may be less clear during the period due to the presence of menstrual blood in the uterus.

Some women may experience mild discomfort or pain during the transvaginal ultrasound due to the insertion of the transducer. However, the procedure is generally well-tolerated and considered safe.

If you have any concerns or questions about having a transvaginal ultrasound during your period, it’s best to speak with your doctor to determine the best course of action for your specific situation.

How to prepare for a transvaginal ultrasound

When the ultrasound appointment is scheduled, you will typically be instructed to drink water and not empty your bladder. This is important because the uterus is located behind the bladder, and a full bladder is necessary to visualise the internal organs during a transabdominal scan. In most instances, however, you may be offered a transvaginal scan instead.

In most cases, minimal preparation is required for a transvaginal ultrasound. We recommend wearing loose comfortable clothing and not bringing any valuable items with you to your scan. Before the scan, you will be asked to remove clothing from the waist down and be provided with a modesty blanket or a hospital gown.

Bladder preparation is not normally required for a routine transvaginal ultrasound therefore, a full bladder is not needed. If however you have been asked to fill your bladder for the scan, it is recommended to drink about half a litre of water or squash about half an hour before the procedure so you feel your bladder comfortably full at your appointment time.

If you are menstruating or experiencing spotting, remember to remove any tampons before the ultrasound.

What happens during a transvaginal ultrasound

During the transvaginal ultrasound, you will be asked to remove your pants and underwear and given a modesty sheet or sometimes a gown to cover yourself with. You will be asked to lie down with your knees bent and legs apart.

The sonographer will apply ultrasound gel to the ultrasound probe and cover the probe with a sterile probe cover which looks the same as a condom. Make sure your sonographer is aware of any latex allergies you have so that a latex-free probe cover is used if necessary. They will insert the probe into the vagina and begin scanning.

The probe emits high-frequency sound waves that create detailed images of the internal organs. The sonographer will assess and image the uterus and ovaries, and note any abnormalities. Sometimes the images may not be clear, especially if there is a lot of abdominal gas in the way and it may be necessary to push into your pelvic area.

It’s worth noting that vaginal ultrasound is not usually performed if the patient has not been sexually active and the probe is disinfected between use.

Does a transvaginal ultrasound hurt?

The scan is not normally painful. However, you may feel some discomfort.

During the transvaginal ultrasound, you may experience some pressure as your sonographer inserts and moves the transducer. This sensation is comparable to the pressure felt during a Pap smear when a speculum is inserted into the vagina. If something is extremely painful, then feel free to tell your sonographer.

How long does a transvaginal ultrasound scan take?

Typically the scan takes between 10 – 20 minutes, however, in certain instances, it can take longer. This could be because of bowel gas obscuring the view to see your womb or ovaries or if you are having a specialist scan such as a HyCoSy.

What are the side effects or risks of undergoing the scan

Transvaginal ultrasound is a generally safe and low-risk procedure. The transvaginal ultrasound is also completely safe to perform in pregnancy for both the mother and fetus. This is because no radiation is used in this imaging technique.

However, as with any medical procedure, there are potential risks and side effects to consider. These may include:

  1. Discomfort or pain during the procedure (common)
  2. Distress related to the results of the procedure

It is important to discuss any concerns or questions about the risks and benefits of the procedure with your doctor prior to undergoing a transvaginal ultrasound.

Can a transvaginal scan cause a miscarriage?

A transvaginal ultrasound is not known to cause a miscarriage. The procedure uses sound waves to produce images of the pelvic organs, which do not carry the same level of risk as other medical procedures such as X-rays or CT scans.

However, it is important to note that if a pregnancy is already threatened or other factors are involved, the transvaginal ultrasound may identify a problem that could lead to a miscarriage. In these cases, the ultrasound is not the cause of the miscarriage but rather an indicator of an existing issue.

It is important to speak with your doctor about any concerns or questions you may have about the potential risks and benefits of a transvaginal ultrasound.

What does a transvaginal ultrasound show?

A transvaginal ultrasound is typically used to detect and assess a variety of conditions and abnormalities within the pelvic region, including:

  • Pregnancy: Transvaginal ultrasound is often used to confirm pregnancy and monitor the growth and development of the fetus.
  • Uterine problems: The test can be used to detect uterine fibroids, polyps, and other growths in the uterus.
  • Ovarian problems: The test can be used to detect ovarian cysts, tumours, and other growths in the ovaries.
  • Ectopic pregnancy: An ectopic pregnancy occurs when the fertilized egg implants outside of the uterus, typically in one of the fallopian tubes. Transvaginal ultrasound can be used to detect an ectopic pregnancy.
  • Pelvic inflammatory disease: This test can help detect pelvic inflammatory disease, which is an infection of the reproductive organs.
  • Endometrial thickening: The test can be used to assess the thickness of the endometrial lining, which can be a sign of a variety of conditions, including endometrial cancer.

It’s important to note that the results of a transvaginal ultrasound should be interpreted by a qualified healthcare provider and that the results may vary based on several factors, such as the stage of pregnancy or menstrual cycle.

Summary

Overall, transvaginal ultrasound is a very safe imaging procedure. The procedure has virtually no side effects, although some people may feel a little discomfort. It is important to make the sonographer aware if you have a latex allergy. The results of the scan may take up to a week for an NHS scan or be provided instantly in a private clinic.

If you experience too much discomfort or can’t tolerate it, transvaginal ultrasound or the procedure is unsuitable for you as you are sexually inactive. An ‘over the tummy scan’ or transabdominal ultrasound is an alternative method of visualising your reproductive organs. The image is, however, not as detailed as a transvaginal ultrasound.

Feel free to ask your sonographer any questions if you are unsure about anything, as they will want to keep you informed and ensure your experience is as comfortable as possible.

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The Scan Clinic is committed to providing accurate and objective educational content about health and medical related topics. We know that there is a lot of misinformation out there, and we take our responsibility to be a trustworthy source of information seriously. Every article on our site is thoroughly fact-checked by our team of writers.

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