Posted on May 30th, 2017 by

I always know that face..the one with the saucer-like eyes and mouth gaping open in utter shock as soon as I speak the words “transvaginal ultrasound” and point to the probe sitting so quietly on my machine. Poor gets such scathing rejection and so little credit.

I can’t really blame the poor patient. After all, a gynecological scan isn’t exactly something people volunteer for (unlike the OB ones! At least they have something cute to look at). I can’t tell you HOW MANY times patients have said, “Boy, these are more fun when there’s a baby in there.” A dollar for every one of those comments and I’d have a penthouse in Manhattan by now.

Most patients still in the baby-making stages of life are typically pretty familiar with a vaginal ultrasound. It’s how we see Baby early in the first trimester or monitor the cervix. But many young or older women are not familiar with my long, skinny friend and are mortified at the thought of this exam. These patients are always there for a problem which could be a whole myriad of issues from crazy periods to ovarian cysts.

One thing is for sure..give me a woman with pelvic pain and, I can promise you, the last thing she wants to see is any ferociously long object headed for her nether-regions! I first apologize then promise patients it’s quick and painless. At least they didn’t have to drink a gallon of water and hold it, which is precisely what some facilities still require for a transabdominal pelvic ultrasound (where we scan on top the belly). It is usually enough to get a slow and deliberately labored “Okaaaaaay, what do I have to do now?” But it’s still a consent! Goal.

Vaginal ultrasound is probably, to me anyway, THE best ultrasound invention since ultrasound’s inception. I tell patients it really is the difference between night and day. It’s much like looking out of a clear glass window versus one with a sheer curtain drawn. I would say that about 95% of the time, I can see better when using the vaginal approach. A very large uterus or pelvic mass, however, would require an abdominal approach.

Did you just say you want a little Ultrasound Physics 101?? Well, I thought so! I’ll make it short. The transvaginal probe is built to deliver a higher-frequency sound wave which doesn’t penetrate very deep into the body. It offers by far the BEST resolution because the uterus and ovaries lie close to the probe. When we scan over the pelvis with a full bladder, the fluid provides a window for the uterus and ovaries behind it. However, by the time the sound waves get all the way down to those organs and back, we have a somewhat compromised image. The vaginal probe requires an empty bladder which allows us to see the uterus better.

We cover the probe with a condom or glove and insert it into the vaginal canal like a tampon. We place the probe against the cervix only; it does NOT enter into the uterus. The cervix remains closed (unless you’re in labor) so it cannot push past this point. The sonographer gets a magnified image of the uterus and ovaries and the areas immediately around them. We measure the uterus, endometrium (lining of the uterus), ovaries, and any pathology that we see related to those organs. Air and gas are not our friends, so sometimes those factors interfere with a good image.

Usually, the whole scan takes about fifteen minutes. When it’s over, the patient usually says it wasn’t that bad at all! Frequently, patients will share the reason for their trepidation. It’s mostly because a friend had one done by a technologist with a heavy hand, making it quite a painful experience. I’ll usually respond by saying, “Firstly, you should ALWAYS tell someone when your exam is that painful. And, secondly, we don’t need to see your tonsils!”  I’m not a comedienne, but that comment usually gets a much-needed laugh, and the end of the scan is very appreciated:)


More coming about transvaginal ultrasound and your early OB scans with the release of my new book about first-trimester ultrasound. Hopefully, very soon! You can receive automatic updates on the book (along with a little something special when it publishes!) and the most current posts by subscribing to my blog. You’ll see where in the right margin! >>

Once again, THANKS FOR READING! And please feel free to email me any questions you have at

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Posted on November 24th, 2014 by

The past week at work has been incredibly busy..chalk it up to a holiday week!  More than the fact that a holiday is approaching is that I have just seen a lot of pathology lately.  More pathology means more time dedicated to each patient’s examination and reporting.

I cannot remember a time when I’ve seen two cases of cancer in one week…one ovarian and the other was a suspected fallopian tube cancer which is very rare.  Either way, it is always a bit dis-heartening to see a mass in the pelvis with concerning size or features.  Sometimes we take one look and just know it is something bad for this patient.  It’s hard for me knowing I have to put a smile on my face and show this patient out the door. I think about how her life will be changed and what she will have to face in the upcoming months. I think about her family and how they must feel upon hearing the news and then facing the repercussions with her.

The only thing that makes me feel a little better is knowing it was caught but feeling a little sad the patient didn’t come in sooner.  We all do it.  We put off symptoms thinking they’ll go away or it’s nothing.  We can’t ignore the things our bodies are trying to tell us.  The best we can do is to address it sooner than later and hope it turns out to be nothing. If nothing is really something, maybe something can be done to treat you now vs having few choices later.

I have thought of those two ladies many times.  I keep checking their charts and with their doctors to follow-up for news.  I have kept them in my prayers.  It makes me a little sad to think of how their holiday might be changed for the worse.  Alternatively, it’s also quite surprising how such news can also be a Pandora’s box of unexpected blessings and thankfulness.  I wish them much of both.


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Posted on November 14th, 2014 by

Gosh, don’t you just hate it when your words gets jumbled in a professional setting and what comes out is anything but? ..professional, that is.

It happened to me this week!  I can laugh about it now and I do have to applaud myself that I kept my composure because it was damned funny at the time.

So, routinely during a pelvic ultrasound, when I cannot find an ovary or see it well with transvaginal imaging I will scan the patient abdominally, as well, and explain this to the patient.  Often times they are surprised or concerned and inquire as to why it is that I cannot see it.  What I usually say is that there is gas and air in the intestines which gets in the way and ultrasound cannot see through that, obscuring the ovary from view.

However, this time instead of gas and air I said, “You know, in the intestines, we have ass and – gas and air..” I didn’t skip a beat and just continued with my spiel. Thankfully, she didn’t even blink!

Yeah, most people haven’t heard of ass and gair..


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Posted on August 9th, 2014 by

Are we ever too old for ultrasound?  Do we ever get to an age where we won’t ever have a need for a pelvic ultrasound exam?  ..Never.

Working for obstetricians means they also manage their patients before and after they have babies which means that not only do I scan many babies but I also perform diagnostic ultrasound on a number of baby-free uteri and accompanying ovaries.  Moreover, my 70-80 year old patients have never even fathomed vaginal imaging.  Unfortunately, we ladies have female issues long before and long after our babies come along..everything from pelvic pain to ovarian cysts to abnormal periods to postmenopausal bleeding. I have heard more than once that they “NEVER thought they’d be doing THIS again”.  I wish I had a dollar for every time I’ve heard this in my career.  I’d probably be in Costa Rica somewhere sipping on a little umbrella drink with my toes in the sand.

My response to them is always the long as you are a woman and your heart is beating, you will ALWAYS have to put your feet in stirrups. We will never ever be too old for ultrasound, a pelvic exam or those awkward metal foot holders. Believe me, it’s not my favorite way to spend 30 minutes, either.  Feet here and slide on down to the end, Ladies!

I’m coming back in my next life as a man.

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Posted on April 13th, 2014 by

There exist a whole plethora of reasons to do an ultrasound on the female pelvis before and after a little bun is baking in the oven.  I know, I know, it’s not as much fun to talk about those “other” things but they are just as important as Baby.  So today’s post is dedicated to the under-appreciated empty uterus.

Our bodies are amazing pieces of fleshy technology!  We are a well-oiled machine, my friend, and the same holds true for GYN parts.  The uterus bleeds like crazy in attempt to remove things that shouldn’t be there or will make us sick and the ovaries produce a cyst and ovulate (release the egg) every single month (for most women).  The lining of our uterus gets thick every month JUST IN CASE a baby might want to implant there and if not, sheds with a period.  Again, this is if your parts are functioning like clock-work.  When they aren’t, my docs come to the rescue.  See, they are not just baby catchers!

Many symptoms warrant your gynecologist to order a pelvic ultrasound.  Abnormal bleeding of any kind at any age is a good place to start..too much bleeding, not enough bleeding, no bleeding, bleeding between periods, painful periods (are any of them pleasant?) and bleeding after menopause are a few of the most common reasons.  Periods are no fun and having one for a month is certainly no celebration!  Pelvic pain or discomfort, bloating or something felt by your doctor during a pelvic exam are other very routine causes for ordering this exam.  Maybe something was diagnosed by a previous ultrasound or CT (CAT scan) and a follow-up was ordered to see if it is resolved.  If you have a family history of some GYN disease, this is yet another indication for ultrasound.  There are certainly many more which is why there are volumes dedicated to the subject in med school.

If one is ordered for you, check with your doctor regarding prep.  Sometimes you have to drink a ton of water for an abdominal scan, most often you don’t in which case this would be a transvaginal ultrasound.  It may sound terrible but it’s not, especially if you are sexually active.  If this is the case (let me think of a politically correct way to say this), the probe is much skinnier than, hopefully, anything that has been introduced to you before.  There.  How was that??  I didn’t say exactly what I wanted here but you get the point.   In other words, if you can manage one, the other will not be a problem!

Here is a link to one of my favorite early posts on the subject of transvaginal exams (you may have to copy and paste the link).  Enjoy!

And since not many people really want to see an image of a uterus or ovary, I’ll attach one of a very cute baby instead!


And what a precious little angel this one is!


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