Transvaginal ultrasound involves inserting a thin transducer (slightly thicker than a tampon) into the vagina to get more detailed images as the transducer is closer to the pelvic organs. This improves the accuracy of diagnosis.

There are times when a transvaginal scan will not be required, and recognise it is not a suitable or acceptable procedure for all women. Transvaginal scans are generally not performed on young girls, women that have not been sexually active and those declining the procedure. If you have concerns, please discuss them with the sonographer. A transvaginal scan is optional for all patients; it is your decision whether to proceed.

Procedure

Your examination will be performed by a sonographer who will introduce themselves and confirm your identity and the procedure you are having. First, a gel is applied to the skin over the area to be examined (lower abdomen/pelvis) to allow the ultrasound probe to move easily over the skin.

After external images have been done, the transvaginal scan will be offered, and you will be asked to empty your bladder and change into a gown. The transvaginal transducer is disinfected before use, and a protective cover is placed over the transducer each time it is used, so there is no risk of infection. The probe is lubricated with gel prior to insertion into the vagina and moved gently to see the pelvic organs. This part of the examination generally only takes 10-15 minutes.

During both parts of the scan, the sonographer may need to mildly push on the abdomen to move bowel out of the way to gain better visualisation and test mobility of pelvic structures. If the examination is causing excessive discomfort or you want to end the examination, advise the sonographer immediately.

Your images will be looked at by a radiologist who will provide a written report for your doctor. Sometimes, the radiologist will speak to you in person during the examination.

Pelvic ultrasound in the diagnosis of deep endometriosis

Many patients with pelvic pain and unsuspected endometriosis will have had a normal pelvic ultrasound at some stage, contributing to a delayed diagnosis. This is because a general pelvic ultrasound looks at the anatomy of the pelvic organs, but doesn’t specifically assess for adhesions or deep endometriosis.

Superficial endometriosis can be widespread but isn’t visible on ultrasound. However, some patients will have deep endometriosis, where endometriotic nodules form beneath the peritoneum. These nodules can be seen on ultrasound, including on the bowel, uterosacral ligaments and bladder.

Identifying the location and size of endometriotic lesions on ultrasound helps gynaecological laparoscopists tailor treatment and plan the appropriate team prior to surgery. Earlier diagnosis allows patients to access appropriate treatment sooner, which has long-term benefits.

At Jones Radiology, ultrasound examination for deep endometriosis is a trans-abdominal scan, followed by a dynamic transvaginal scan (internal), which includes:

• The uterus assessed for mobility and associated adenomyosis
• The ovaries examined for adhesions and endometriomas
• The lower bowel examined for endometriotic nodules
• The vaginal wall, retro-cervical space and Pouch of Douglas examined for free fluid, adhesions and nodules of deep endometriosis
• An assessment of locations of pelvic tenderness

The Australian Government has also introduced Medicare-supported funding for complex pelvic ultrasound, including the dynamic assessment techniques used to investigate deep endometriosis, to help make this more accessible.

If you are experiencing symptoms that may suggest endometriosis, speak with your general practitioner. If they have any concerns, they may refer you for a dynamic pelvic ultrasound to investigate deep endometriosis.

To find out more, visit our latest news for updates on endometriosis.

Endometriosis – 
Jones Radiology

Before your Scan

A pelvic ultrasound can be performed at any stage of a woman’s menstrual cycle. To achieve the best scan results, for women still menstruating, and particularly if we are investigating heavy bleeding or possible polyps the scan is best done on day 4-9 of your menstrual cycle when the lining of the uterus is thinnest. If you are in pain or your referring doctor requires the examination to be done urgently, then your appointment can be made sooner or at any stage of your cycle.

If possible, wear clothing that allows easy access to the area that is being imaged, such as two-piece clothing (separate upper/lower garments).

Transabdominal:  A full bladder is required. Drink one litre of water finishing one hour before your appointment and do not empty your bladder. Distension (expansion) of your bladder gives clearer images of your pelvic organs and compresses your bowel out of the way. If you are feeling overly full and it is causing you pain or distress, please tell reception staff on arrival who will talk to you about your options.

Transvaginal: This ultrasound is done with an empty bladder which you may find more comfortable.

Preparation details will be confirmed when you make your appointment.

Duration

Approximately 30 minutes.