Transvaginal Ultrasound

What is a transvaginal ultrasound?

A transvaginal ultrasound is an imaging procedure that allows your provider to see your pelvic cavity and the organs inside your pelvis. These organs include your cervix, uterus, fallopian tubes and ovaries. A transvaginal ultrasound can show abnormal structures or growths in your pelvic area that may indicate a condition or disease. Your provider may also order a transvaginal ultrasound to confirm or monitor your pregnancy.

What is the difference between an ultrasound and a transvaginal ultrasound?

Transvaginal ultrasounds are sometimes called “endovaginal ultrasounds” because the device that records images of your pelvic cavity (transducer) is inserted inside your vagina. The process is different from a traditional abdominal ultrasound, where your provider moves the transducer across your belly to record images.

A transvaginal ultrasound provides a more detailed visual of your organs and the soft tissue inside your pelvic cavity than an abdominal ultrasound. But, an abdominal ultrasound is an option if a transvaginal ultrasound cannot be done. For instance, if you’re pregnant and the placenta (the organ that provides nutrients to your baby) is near your cervix, a transvaginal ultrasound may cause unnecessary bleeding.

When is a transvaginal ultrasound performed?

There aren’t many restrictions or limiting factors when your provider can perform a transvaginal ultrasound. For instance, your provider may order this procedure regardless of whether or not you’re menstruating or pregnant.

There are limitations If your provider recommends a special kind of transvaginal ultrasound called saline infusion sonohysterography, or a sonohysterogram. A sonohysterogram is when a small amount of fluid is used to distend the cavity of the uterus to allow a good imaging view of the lining. You shouldn't have a sonohysterogram if you’re pregnant or have pelvic inflammatory disease (PID).

When would a transvaginal ultrasound be needed?

Your provider may order a transvaginal ultrasound to diagnose conditions causing unpleasant symptoms, like pelvic pain or abnormal bleeding. Transvaginal ultrasounds can provide further information about abnormalities discovered during a pelvic exam that can lead to a diagnosis. Transvaginal ultrasounds may also be used to monitor your pregnancy.

A transvaginal ultrasound allows your provider to identify:

• Cysts.
• Tumors.
• Fibroids.
• Polyps.
• Signs of a pelvic infection.
• Signs of cancer.
• Signs of ectopic pregnancy or miscarriage.
• Potential causes of fertility issues.
• If an intrauterine device (IUD) is in the correct position.

Your provider may order a transvaginal during pregnancy, especially during the first trimester (weeks one to 12). Your provider may order a transvaginal ultrasound to:

• Confirm your pregnancy.
• Determine how far along you are in your pregnancy.
• Monitor your baby’s heartbeat.
• Identify warning signs of a miscarriage or early delivery.
• Identify conditions that will affect your pregnancy plan, like having a low-lying placenta (placenta previa).

A transvaginal ultrasound can also help your provider plan for surgery.

Who performs a transvaginal ultrasound?

Your provider or a trained specialist called a sonographer, or ultrasound technician may perform the procedure. In some instances, a trained radiologist may perform the procedure and share the results with your provider.

How does a transvaginal ultrasound work?

A transvaginal ultrasound uses sound waves to record your pelvic cavity and organs and project these images onto a screen. A wand-like instrument called a transducer is inserted into your vagina, where it releases sound waves that bounce off the various structures inside your pelvis. The sound waves travel back to the transducer, where they’re converted into electrical signals. These signals project a real-time visual image of your pelvic organs onto a screen that the technician performing the procedure can view.

The ultrasound captures still images of the visuals on screen, too, so that your provider can examine them later. The image produced during an ultrasound is called a “sonogram.”

How long does a transvaginal ultrasound take?

A transvaginal ultrasound can take anywhere from 15 minutes to an hour.

How do I prepare for a transvaginal ultrasound?

Transvaginal ultrasounds don’t require much preparation. The procedure is quick and relatively painless, with little risk of side effects. You shouldn’t have to plan for someone to drive you home or to work afterward.

To prepare:

• Wear clothes that you can slip out of easily. You will have to remove your pants and underwear, and you may have to wear a gown.
• Remove your tampon before the procedure if you’re on your period.
• Follow your provider’s instructions about when to drink fluids and go to the bathroom. Having a full bladder affects the way your organs appear on an ultrasound. You may need to arrive at your appointment with a bladder that’s empty, full or partially full.

Do I need to shave for a transvaginal ultrasound?

No. Having pubic hair won’t prevent you from having an ultrasound. Groom to your comfort before the procedure.

What should I expect during a transvaginal ultrasound?

Your ultrasound will occur in an ultrasound room in a hospital, private radiology practice or clinic for obstetric and gynecological imaging. In some instances, your provider may order an abdominal ultrasound before your transvaginal ultrasound. Both imaging procedures together provide a more comprehensive view of your pelvic organs that may be needed, depending on your symptoms.

1. You’ll lie on an examination table as if you were having a pelvic exam — with your knees bent, and your feet possibly in stirrups.
2. Your provider will place a condom and a warm lubricating gel on the transducer and gently insert it inside your vagina.
3. Once it’s inside your body, the transducer releases sound waves that record pictures of your pelvic organs. These images get projected onto a screen. The technician performing the ultrasound may ask that you lie still or shift your body so that the transducer can record your pelvic cavity from different angles.

The technician may perform additional steps if you’re having saline-infusion sonography, or a sonohysterogram.

Once enough images are taken for a thorough analysis, the technician will remove the transducer.

Is a transvaginal ultrasound painful?

No. The transducer is designed to curve to your vagina’s shape so that the procedure is as painless as possible. Also, the lubricating gel placed on the transducer allows for gentle insertion. Still, you may feel some discomfort or pressure when the technician inserts the transducer into your vagina. The process may feel similar to a Pap smear, when your provider uses a speculum to widen the opening in order to access your cervix.

What are the risks of a transvaginal ultrasound?

Transvaginal ultrasounds are safe. The sound technology used to record images of your pelvis doesn’t pose risks to you or your fetus if you’re pregnant. You may feel slight discomfort or pressure from the transducer. And you may have a slight vaginal discharge from the lubricating gel used during the procedure that should disappear after 24 hours.

What type of results do you get after a transvaginal ultrasound?

If your provider performs the procedure, they may discuss your results with you that same day. Or, they may send the images to a certified physician sonologist for analysis. The sonologist will examine your ultrasound images and type up a report communicating their findings to your provider.

Your test results may provide enough information for a definitive diagnosis. Alternatively, your provider may request additional testing if there’s uncertainty. Ask your provider about how your results will affect your care plan.

A note from Cleveland Clinic

A transvaginal ultrasound is a common procedure that can help your provider identify what’s causing unpleasant symptoms you may be experiencing. It requires little effort on your part while providing helpful information to your provider about conditions that require a range of treatment options. Speak to your provider about how having a transvaginal ultrasound will inform the next steps of your care.