A transvaginal ultrasound, also called transvaginal sonogram (TVS), is an ultrasound that uses an internal probe, or transducer, that enters the vaginal cavity.
Either a radiology technician or physician performs the test, and a radiologist interprets the results.
An internal probe allows for closer access to the structures that need evaluation.
With closer access, higher frequency sound waves can be used, which provides a clearer image due to better resolution.
It is often used to evaluate suspected cancer or abnormal growths in the female reproductive system.
Although the transvaginal ultrasound produces a clearer image, it may also create false-positive results.
This can lead to unnecessary testing to further evaluate the condition, accompanying physical and emotional impact.
The transvaginal ultrasound uses a small, wand-like transducer or probe inserted into the vagina.
The probe emits high-frequency sound waves, which are not audible by humans.
These sound waves painlessly bounce off the structures in their path.
The probe picks up the returning echo wave. This information is fed into an attached computer that then creates an image, or sonogram, on a screen.
It can differentiate between solid structures, such as a tumor, or filled with fluid, such as a cyst.
It may be used to measure the thickness of the lining of the uterus and other organs.
A technique called color flow Doppler imaging may be used to evaluate the blood flow to certain structures.
This can help establish whether blood flow has been obstructed or enhanced to an organ. It cannot tell if a solid mass is malignant or benign.
Other tests, such as a biopsy, would be needed to gather that information.
It is done daily, is less expensive than imaging tests such as magnetic resonance imaging (MRI), and is considered safe, using sound waves rather than radiation to generate an image.
Little preparation is needed for the transvaginal ultrasound. A woman will need to undress from the waist down and lie face-up on the examination surface.
Legs may be put in stirrups, or a bolster may be placed under the hips to tilt the pelvic area upward to facilitate the use of the probe, both for insertion as well as for the ultrasound process itself.
The testing is performed with an empty bladder, which is more comfortable than the full bladder required for the abdominal ultrasound.
This method may be a preferred choice for women who have difficulty with bladder control.
A woman may wish to request that she insert the probe herself, which is similar to the insertion of a tampon.
A gel that has been warmed will make insertion more comfortable.
Because of the low quantity of gel used on the probe for easier insertion, a woman could wish to apply a hygienic pack to protect her underclothes from possible minor leakage after getting up.
After the procedure, a woman will be able to resume her regular scheduled activities.
The risk involved in using the transvaginal ultrasound is obtaining a false positive result, any resulting tests that would be ordered unnecessarily, and their accompanying emotional burden.
The normal results of a transvaginal ultrasound are finding the normal shape and size of any structure evaluated, with no abnormal thickness, masses, or growths of any kind found.
Abnormal results include the finding of growths, such as masses or cysts, and any unexpected thickness of the structures evaluated.
Due to the chance of false-positive results, any abnormal findings should be further evaluated and confirmed before considering surgery or treatment for the suspected condition.
Magnetic resonance imaging (MRI) is often ordered to evaluate masses further.
An endometrial biopsy is performed to evaluate a thickened uterine lining further.
- Biopsy— Removal of cells or tissues for examination by a pathologist.
- False-positive— A test result that incorrectly indicates that a particular condition or attribute is present.
- Magnetic resonance imaging (MRI)— A procedure in which radio waves and a powerful magnet linked to a computer are used to create detailed pictures of areas inside the body.
- Radiologist— A doctor who has special training in creating and interpreting pictures of areas inside the body, made with x-rays, sound waves, or other types of energy.
- Ultrasound— A procedure that uses high-energy sound waves to look at tissues and organs inside the body.
QUESTIONS TO ASK YOUR DOCTOR
- What are you looking for with this test?
- Who will perform the test? Is that person board-certified?
- Who will read the results? Is that person board-certified?
- Does the facility utilize color flow Doppler imaging?
- When, how, and from whom will I receive the results?
- If the result is positive, how will you evaluate if it was a false positive?
- Will my insurance cover the cost of this test?
Steiner, E., et al. “Transvaginal Ultrasound for Endometrial Carcinoma Screening: Current Evidence-Based Data.” Geburtshilfe und Frauenheilkunde 72, no. 12 (2012): 1088–91.
Mayo Clinic. “Transvaginal Ultrasound.” https://www.mayoclinic.org/diseases-conditions/pcos/multimedia/transvaginal-ultrasound/img-20007770 (accessed April 16,2020).
“Transvaginal Ultrasound.” MedlinePlus. https://medlineplus.gov/ency/article/003779.htm (accessed April 9, 2020).
Esther Csapo Rastegari, RN, BSN, EdM