Transvaginal ultrasound
Transvaginal ultrasound, also known as a transvaginal sonogram, is a diagnostic procedure that utilizes an internal probe to examine the female reproductive organs. This method is especially useful for assessing conditions such as dysfunctional uterine bleeding, pelvic masses, ectopic pregnancies, and pelvic inflammatory diseases. In postmenopausal women, it helps evaluate the endometrial thickness to check for hyperplasia or cancer, as routine examinations may not reveal ovarian conditions due to changes after menopause.
The procedure requires minimal preparation; patients typically undress from the waist down and may either insert the probe themselves or have it inserted by a healthcare professional, using a lubricating gel for comfort. Transvaginal ultrasound is radiation-free, with results available immediately, and can be performed by trained technicians or radiologists. The findings can either be normal, indicating no abnormalities, or abnormal, suggesting the presence of masses or unusual growths that may require further investigation. Recent advancements have improved the accuracy of transvaginal ultrasound in diagnosing ovarian cancer, particularly when combined with other diagnostic tools. Overall, this procedure remains a highly effective, affordable, and accessible option for women's health assessments.
On this Page
Transvaginal ultrasound
ALSO KNOWN AS: Transvaginal sonogram
DEFINITION: Transvaginal ultrasound is a diagnostic procedure that uses an internal probe or transducer to enter the vagina.
Cancers diagnosed:Uterine cancer, ovarian cancer, and endometrial cancers; noncancerous fibroids
Why performed: Transvaginal ultrasound is a diagnostic procedure used to evaluate women with dysfunctional uterine bleeding to detect pelvic masses, ectopic pregnancy, and pelvic inflammatory disease. In postmenopausal women, the thickness of the endometrium is evaluated to check for overgrowth (hyperplasia) or cancer. Since the ovaries shrink after menopause, a gynecologist cannot feel them during a routine pelvic examination. The ovaries can be examined by transvaginal ultrasound.
Patient preparation: Little preparation is needed for the transvaginal ultrasound. The patient undresses from the waist down and lies face-up on the examination table. Either the patient will place her feet in stirrups, or a bolster is placed under the hips to tilt the pelvis upward for insertion of the probe as well as the examination. The bladder is empty.
Steps of the procedure: Often, the woman inserts the probe herself (similar to inserting a tampon). Warm gel is used to lubricate the probe. There may be slight pressure when the transducer is inserted. A transducer is used to transmit high-frequency sound waves, which bounce back to produce images that can be seen on a video monitor or recorded on X-ray film. There is no radiation exposure during transvaginal ultrasound, and the results are available immediately. The procedure is performed by a radiological technician or physician radiologist and read by a physician radiologist.
After the procedure: The patient can resume normal activities immediately. There may be a small amount of leakage from the gel used, which can be absorbed by using a sanitary pad.
Risks: No risks are associated with this procedure.
Results: The results of a transvaginal ultrasound may be normal or abnormal. Normal results mean that no abnormal areas are found in the uterus. It is normal in shape and size with no abnormal thickness, masses, or growths. Abnormal results include growths (masses or cysts) and unanticipated thickness. Because there is a risk of false positive results, abnormal findings should be evaluated and confirmed by magnetic resonance imaging (MRI) or biopsy.
Advancements specific to the diagnosis of ovarian cancer through transvaginal ultrasound have been made in the twenty-first century. While transvaginal ultrasound remained a highly effective, affordable, and easily accessible diagnostic tool for ovarian cancer, in the past, the procedure’s ability to distinguish between benign and malignant tumors was lacking. Combining transvaginal ultrasound with other therapies, including serum biomarkers and tumor morphology indexing, which assigns a grade to tumors found with transvaginal ultrasound, has further increased its effectiveness. Microbubble contrast-enhanced ultrasound and photoacoustic imaging are two additional therapies that improved the effectiveness of transvaginal ultrasound in diagnosing cancer.
Bibliography
Benacerraf, Beryl R., Steven R. Goldstein, and Yvette S. Groszmann. Gynecologic Ultrasound: A Problem-Based Approach. Philadelphia: Saunders-Elsevier, 2014.
Fratelli, Nicola, et al. "Transvaginal Sonography for Preoperative Assessment of Deep Endometriosis." Journal of Clinical Ultrasound, vol. 41.2, 2013, pp. 69–75.
Gorski, Justin W. “Advances in Early Detection of Ovarian Cancer.” Norton Healthcare Provider, 16 Nov. 2022, nortonhealthcareprovider.com/news/transvaginal-ultrasound-ovarian-cancer. Accessed 20 June 2024.
Hoff, John T. "Transvaginal Ultrasonography in Ovarian Cancer Screening: Current Perspectives." International Journal of Women's Health, vol. 6, 2014, pp. 25-33, doi.org/10.2147/IJWH.S38347. Accessed 20 June 2024.
Liberto, Juliane M., et al. "Current and Emerging Methods for Ovarian Cancer Screening and Diagnostics: A Comprehensive Review." Cancers, vol. 14, no. 12, 2022, doi.org/10.3390/cancers14122885. Accessed 20 June 2024.
Malhotra, Narendra, et al., eds. Ultrasound in Obstetrics & Gynecology. 4th ed., New Delhi: Jaypee, 2014.
Mavrelos, D., et al. "Diagnosis of Uterine Vein Thrombosis on Transvaginal Ultrasound." Ultrasound in Obstetrics & Gynecology, vol. 42.4, 2013, pp. 480–83.
Nagell, John R. van, Jr., and John T. Hoff. "Transvaginal Ultrasonography in Ovarian Cancer Screening: Current Perspectives." International Journal of Women's Health, vol. 6, 2014, pp. 25–33.