Posted on May 30th, 2017 by wombwithaviewblog.com
transvaginal ultrasound, endovaginal, TV probe

TV Probe


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.” I point to the probe sitting so innocently on my machine. Poor thing…it gets such scathing rejection and so little credit!

I can’t really blame the patient. After all, a gynecological scan isn’t exactly something people volunteer for (unlike the OB ones – at least they have something cute to ogle!). 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 transvaginal 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. Some are mortified at the thought of this exam. To note, these patients are always there because of a problem which could be a whole myriad of issues from crazy periods to ovarian cysts.

The Transvaginal Ultrasound Protocol

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 down south. I first apologize then promise that it’s quick and painless. I also add that at least they didn’t have to drink a gallon of water and hold it. Okay, I’m over-exaggerating. Some facilities still require patients to drink approximately 32 ozs of fluid for a transabdominal pelvic ultrasound (a scan on top the belly). You can read more about bladder preps here: How Much Water to Drink for Your Ultrasound

This little fact is usually enough to get a deliberately labored, “Okaaaaaay, what do I have to do now?” But it’s still a consent! Goal.

Transvaginal Ultrasound Provides You a Better Exam!

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. Be sure to let your sonographer know if you have a latex allergy! 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 be inserted past this point. The sonographer obtains 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.

How Long Does a Transvaginal Ultrasound Take?

About fifteen minutes, longer if the exam is complicated by pathology or if views we need are difficult to obtain. (By the way, “pathology” doesn’t always mean a worrisome or dangerous process!) When it’s over, the patient usually says the exam wasn’t that bad at all! Frequently, they 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 much appreciated:)

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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 wombviewerblog@gmail.com.

Best wishes!
wwavblogger, RDMS
wwavblogger, RDMS

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Posted on June 28th, 2015 by wombwithaviewblog.com

Today’s post is an extension of the last, expounding a little more on the technical details of the transvaginal ultrasound.  As I mentioned previously, this approach to the pelvic organs has been the most impressive addition to the modality and the best way to image these organs.

There is no prep for this exam unlike the dreaded filling of the bladder for the abdominal approach.  Moreover, an empty bladder is required since too much urine will cause the bladder to push the uterus too far back, yielding a limited image.

The exam typically takes me about 10-15 minutes in a normal exam.  Everyone’s organs are positioned a little differently so a challenging angle or needing to document a lot of pathology can certainly cause your exam to run longer.  The uterus tilted backwards, the ovaries too high in the pelvis and intestines in the wrong place all make for a difficult or limited examination.  The intestines, or bowel loops, contain air and gas through which sound waves cannot penetrate.  Therefore, bowel sitting on top of your ovary can obscure the view altogether.  Oftentimes I can push around a little to obtain a better view or I’ll look abdominally anyway in an effort to see something, anything I couldn’t internally.  If your uterus is REALLY large (as in the case of large fibroids), I’m going to scan you abdominally anyway.

We measure the uterus and ovaries and document any pathology we see.  Uterine fibroids (a very common tumor of the uterine muscle, endometrial polyps (like a skin tag in the lining of your uterus), ovarian cysts or masses and fluid in the fallopian tubes are just some of the processes we see on a regular basis.  The exams are typically ordered by your doctor if you are experiencing pelvic pain or pressure, if something is felt on your pelvic exam or if you describe any myriad of problems with your period.  There are volumes of other reasons to perform this exam but the above are some of the most common.  A regular misperception I have found with the general public is they don’t realize ovarian cysts can be functional..meaning this is what the ovary does normally every month when we ovulate.  A cyst forms, ruptures, the egg is released..voila!  Ovulation.  So many come in exclaiming ovarian cysts like they have a disease.  More often than not, it’s just a normal finding.

There are no side effects of the exam and it shouldn’t hurt.  Sometimes, if you come in with pelvic pain already, the exam may feel a little uncomfortable.  Most people complain of pressure on the bladder.  If it’s painful, let your sonographer know!  Sometimes “newbies” push too hard, unbeknownst to them.

When my patients come in stressed out about the exam, fearful because it hurt the last time they had one done or exhibit a little trepidation, I always try to lighten the mood with the same line.  “No, worries.. I just have to find your ovaries, not your tonsils!”  I always get a laugh and a thank you out of that;)

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Posted on April 17th, 2014 by wombwithaviewblog.com

Oh, what our poor patients experience at the hands of our inexperience and in the name of education.

Ya know, one of the things students learn is not only how to use the buttons on the machine, not only how many images to take and what kind, not only how to detect pathology but also how to (or how not to) insert a transvaginal probe.  It can be a little tricky!  We are not gynecologists, sitting there with our head between our patient’s legs, however, there is a right way and a very wrong way to place this probe.  The vagina can be an elusive little boogar depending on a patient’s body shape and, especially if you are at all very new to vaginal probe placement.  One suggestion to a new sonographer is not to try this with your eyes closed.  The gel on the end of that thing can make it feel like a slip-n-slide down there if you’re not careful!  Just like you have to look at the road to know you are in the correct lane, you also have to look at your patient, briefly, to ensure the probe doesn’t migrate..well, south.

Read part of an email from a pregnant patient:

reader:  I had a (pretty harrowing) ultrasound at 7 weeks due to pain and spotting, in which the student tech tried to insert the probe into my anus, twice (really). She didn’t so much as wipe it before shoving it very hard into the correct orifice :-/  Actually there was another lady in the room, but she was tapping away on a computer. When I yelped due to the wandering wand, she looked up and asked if the student needed help, but she said no and continued. I suspected she was a student because of this episode, and sure enough my little report confirmed it.

wwavblogger:  Let me just say that your email and the case of mistaken orifice identity is unfortunate but you totally made me laugh (really).  One of the things a new sonographer has to learn about using a probe is how to insert it.  So sorry this was your experience.  I’m interested in knowing, though, if there was an experienced sonographer supervising her?  Did she say she was a student?  Just curious..  Students and new sonographers should always be supervised.  It’s a peeve of mine when this doesn’t happen!

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Patients, speak up if this happens to you!  If you have questions about the competence of your sonographer, you have every right to discuss the concern with your doctor.  Sonographers, pay attention to what you are doing.  If you are unsure, you have to learn to ask the patient if the probe feels like it is in the vaginal canal.  Believe me, she’ll let you know if you are flying south.

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Posted on April 13th, 2014 by wombwithaviewblog.com

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!

http://www.wombwithaviewblog.com/youre-gonna-put-what-where/

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!

IMG_1439

And what a precious little angel this one is!

 

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