Pelvic and Transvaginal Ultrasound
Pelvic ultrasound is an extremely important diagnostic procedure in the field of gynecology and women’s health. This procedure, based on ultrasound and advanced imaging technologies, allows for an accurate assessment of the female pelvic organs. The use of ultrasound to generate images of the external pelvic organs, such as the uterus, ovaries, and bladder, is completely safe and harmless to body tissues. Ultrasound is a noninvasive diagnostic examination used to identify any structural abnormalities, ovarian cysts, uterine fibroids, or other gynecological conditions. Specifically, we technically distinguish:
What is a pelvic ultrasound?
Pelvic ultrasound is a key diagnostic procedure in the field of gynecology and beyond. It is a noninvasive examination that uses ultrasound to create images of thefemale reproductive system, including the uterus, ovaries and fallopian tubes, as well as the bladder. This technique is extremely useful for assessing the presence of structural abnormalities, cysts, fibroids or other conditions that could affect reproductive health or cause symptoms such as pelvic pain or abnormal bleeding.
Because of its noninvasive nature, pelvic ultrasound is often one of the first examinations performed when a woman sees her physician for gynecological problems or during routine checkups. The examination can be conducted through the abdominal wall (external pelvic ultrasound) or by introducing a transducer into the vagina (transvaginal ultrasound) to obtain more detailed images.
The importance ofpelvic ultrasonography lies in its ability to provide valuable information without the need for surgery or more invasive procedures, thus enabling early and accurate diagnosis of various conditions. This makes the examination an indispensable tool in modern gynecologic practice.
What is transvaginal ultrasound?
Transvaginal ultrasound is a specific variant of pelvic ultrasound, designed to provide high-resolution images of the interior of thefemale reproductive system. Unlike traditional pelvic ultrasound, which is performed by placing the transducer on the abdominal surface, transvaginal ultrasound involves introducing a thin transducer into the vagina. This methodology allows us to get considerably closer to the pelvic organs, thus obtaining clearer and more detailed images of the uterus, ovaries and fallopian tubes.
Because of its high diagnostic accuracy, transvaginal ultrasound is particularly useful in detecting conditions such as endometrial polyps, uterine fibroids, ovarian cysts, and uterine developmental abnormalities. In addition, it is often used in monitoring ovulation in women seeking pregnancy, assessing fertility, and early diagnosis of pregnancy, including verification of embryo position.
A significant advantage oftransvaginal ultrasound is its ability to provide detailed information even when the bladder is not completely full, unlike traditional pelvic ultrasound, which requires specific preparation in this regard. This makes it an extremely versatile and accessible tool for diagnosis in a variety of clinical settings.
Despite its slightly more invasive nature than external pelvic ultrasound, transvaginal ultrasound is generally well tolerated, with minimal discomfort for the patient. Its diagnostic efficacy and ability to provide timely and accurate assessments make it an essential component of women’s health management.
When are they indicated?
Indications for pelvic and transvaginal ultrasound are broad and vary according to specific diagnostic needs. These examinations are often recommended in the presence of gynecological symptoms such as pelvic pain, abnormal bleeding, or irregularities in the menstrual cycle. In addition, they are crucial tools in the assessment of reproductive health, allowing investigating causes of infertility, monitoring the ovulatory cycle, or assessing fetal well-being during pregnancy.
For pelvic ultrasound, indications include:
- Pelvic pain: To identify the cause of chronic or acute pain in the pelvic region.
- Abnormal bleeding: To examine the possible causes of heavy, irregular menses or postmenopausal bleeding.
- Evaluation of pelvic masses: Such as ovarian cysts or uterine fibroids.
For transvaginal ultrasound, indications may be more specific, such as:
- Early diagnosis of pregnancy: To confirm the presence and correct position of the embryo within the uterus.
- Fertility assessment: To observe ovarian morphology and the possible presence of ovulatory follicles.
- Infertility investigation: To examine the condition of the uterus and fallopian tubes that could affect the ability to conceive.
Both examinations are also used as part of routine checks in women’s health management, especially for women who are at risk of developing gynecological conditions based on family history or preexisting symptoms.
How is a pelvic ultrasound performed?
Pelvic ultrasound is a simple, noninvasive examination that does not require complex preparation. To obtain clear images, it is generally recommended to present to the examination with a moderately full bladder, as the fluid improves ultrasound transmission and allows optimal visualization of the pelvic organs.
During the examination, the patient lies on a crib and uncovers the lower abdomen. The physician or technician applies a conductive gel to the skin to reduce air between the ultrasound probe and the skin, improving the quality of the images obtained. The probe, or transducer, is then gently moved over the patient’s skin in the pelvic area, sending high-frequency sound waves that bounce off internal organs, creating images displayed on a screen.
The examination generally takes between 15 and 30 minutes and is painless, although some patients may experience mild discomfort due to the pressure of the transducer on the abdomen, especially if they have a full bladder.
How is a transvaginal ultrasound performed?
Transvaginal ultrasound requires slightly different preparation than pelvicultrasound, as it is preferable to have an empty bladder to facilitate transducer insertion and improve image quality.
For the examination, the patient is asked to lie on a couch, with knees bent and spread apart. A long, thin transducer specifically designed for vaginal insertion is used. The transducer is covered with a disposable condom and lubricated to make the insertion as comfortable as possible.
Once gently inserted into the vagina, the transducer is oriented in different directions to obtain detailed images of the uterus, fallopian tubes and ovaries. Although the examination may cause a feeling of pressure, it should not cause pain. The duration of transvaginal ultrasound is similar to that of pelvic ultrasound, generally varying from 15 to 30 minutes.
Both examinations are safe procedures that are performed by trained personnel, ensuring respect and comfort for the patient throughout the examination.
Preparation for examsi
Preparation for pelvic and transvaginal ultrasound varies slightly depending on the type of examination. However, both require some simple measures to ensure that the images obtained are as clear as possible.
For pelvic ultrasound
- Full bladder: It is advisable to drink about one liter of water one hour before the appointment and not empty the bladder until the exam is completed. A full bladder lifts the bowel out of the pelvic area and improves visibility of the pelvic organs.
- Comfortable clothing: Wearing clothing that allows easy access to the pelvic area can facilitate the procedure.
- No special food preparation is necessary before pelvic ultrasound.
For transvaginal ultrasound
- Empty bladder: Unlike pelvic ultrasound, for transvaginal ultrasound it is preferable to have an empty bladder. This may involve the instruction to empty the bladder just before the exam.
- Relaxation: Since the examination involves the insertion of a transducer into the vagina, maintaining a relaxed condition can help reduce any discomfort.
For both exams, it is important to communicate with the health care professional about any concerns, questions, or pre-existing medical conditions, such as an allergy to the gel used during the ultrasound. In addition, informing the health care professional if you are pregnant is crucial, as this may affect how the exam is conducted.
Risks and contraindications
Both pelvic and transvaginal ultrasound are considered extremely safe procedures . They do not use ionizing radiation, such as X-rays, which means there is no risk of radiation exposure. Complications are extremely rare.
However, transvaginal ultrasound may cause mild discomfort due to the pressure of the inserted transducer. In very rare cases, an allergic reaction to the gel used on the transducer may occur, but this is easily managed.
There are no real contraindications to performing these examinations, although communication with the physician is essential to ensure that the examination is performed under optimal conditions and with the utmost care for the patient’s well-being.
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