Pelvic transvaginal ultrasound - what's it like?

I'm booked for a "pelvic transvaginal ultrasound" on 12th September, to investigate the cause of my severe period pain.

The NHS website says "may cause some discomfort, but don't usually cause any pain". I'm hoping that some people here who have had this procedure can confirm whether this is an accurate description?

 

I had one. Definitely less uncomfortable than a cervical smear!! So yes description seems right, it was certainly less difficult than I anticipated.

Though i imagine there are a few “it depends” scenarios

xx

 

Cervical smear was really easy for me (apparently my cervix is really easy to find) so that’s reassuring to hear.

Sounds like the worst part might be having to have a very full bladder…

 

Hi @Sarah94, I can comment from the sonographer's viewpoint, if that's helpful.

Usually this is done in two stages, transabdominal (TA) and transvaginal (TV). TA looks through the abdominal wall, hence the full bladder for an acoustic window to uterus and ovaries. Also usually the kidneys will be scanned, so they'll ask you to turn to lie on either side. Sometimes the ovaries might only be seen TA, but usually you get much better detail TV. Then you can go to the loo to empty your bladder before the TV scan. This is more comfortable for the patient (obvs) but actually gives a better view too.

Most sonographers are female, but I and other male practitioners can also do this type of scan, though there would be a female chaperone (which can be your support person if all feel comfortable).

You'll probably be in a shortish gown, but have a towel or blanket to keep you covered. The TV probe is covered with a condom and has lots of KY jelly. It's sterilised between each case also. Often the patient is offered to place the probe internally themselves, though many patients actually prefer we just go ahead and do that as it's actually much more straightforward. Like many things in medicine this is all routine for us, but we appreciate it's anything but for each patient, particularly if they've never had one before. As mentioned above it's probably a lot less "bother" than a smear. Sometimes they'll put a pillow under your pelvis to improve the angle and view. Or you might put a fist under either buttock to tilt each way. I'm sure they will accomodate any mobility / strength issues you have on the day. As the probe is gently moved, they can get a dynamic view of how well the ovaries and adjacent bowel loops move. If they don't move freely that can be a clue to endometriosis.

Spoiler: In terms of size

The probe itself is a bit longer, but maybe two-thirds diameter than something, ahem, recreational. It does have a moderately bulbous end which gives the image a wide field of view.

 

Not painful, depending on the angle sometimes a little uncomfortable in my experience.

 

I have had these TV ultrasounds many many times - approx 20-25 times over the last 17 yrs (had ME all of that time). Can confirm they are nothing to worry about, i have even had them during mild PEM & not painful.
Since i had a gynae op 25yrs ago i find smears excruciating to the point of tears, but the scans are no issue at all, so if you managed a smear without issue then i'd expect the scan to cause no problem at all.

Occasionally a little uncomfortable at certain angles, but i mean uncomfortable not painful, and it's transient - lasts seconds.

PM me if you'd like a more detailed description of the procedure - its a bit 'uncomfortable' to describe on open forum for me

 

Also here’s a picture I found on the internet of a cat having an ultrasound.

https://twitter.com/user/status/1555540797822492673


I imagine the cat is saying “you’re telling me WHAT is going to come out of WHERE?!!”

 

Thank you this is really helpful!!

 

I had these scans as part of investigations for cysts and Endometriosis. Found the TV scan painful as they pushed it into areas which presumably had the endo. If you have times of the month when there is the least pain from your pelvis it might pay to book in for one of these.
Interestingly, it wasn't until I had a scan (can't remember if it was a CT or a MRI now) that the full extent of the Endometriosis was found.

 

I find TV scans pain-free. I also had this investigation a few years back for the same, but everything appeared normal. My heavy and painful periods persisted, and new debilitating symptoms developed right before menstruation. So I had another TV scan a couple of months ago for private investigations to find the cause.

Fingers crossed your TV scan reveals something treatable, but if not, don't stop there, as my new endo doctor traced the problem back to a hormonal imbalance. I currently receive NHS treatment to manage it now.

Some tell-tale signs are worsening symptoms around 1 week before menstruation, including mood changes.

 

I had a pelvic transvaginal ultrasound some years ago, and I found it much less uncomfortable than a regular cervical exam. They did have me use the wand myself once it was inserted. It was all a little weird, but not painful.

 

How did you get on? I am having similar investigations.

I read that a large proportion of women with a 'CFS' dx also have an Endometriosis dx, and that Endometriosis pain often does not correlate with the severity/extent of the physical Endometriosis, and that a high proportion of people with an Endometriosis dx experience fatigue varying from mild to severe. And that Endometriosis is very underdiagnosed. This got me wondering - what if fatigue does correlate with the severity of the physical issue, even though it doesn't correlate with pain, and lots of people have undiagnosed Endometriosis because they never have pain, but have 'unexplained' fatigue from that undiagnosed Endometriosis?

Will see if I can find the studies I read.

 

It was fine, scan was a bit uncomfortable but not really painful.

I don’t have endometriosis. We have been treating me with bio-identical progesterone and I have a lot less pain now.

 

Thanks for the update, glad you had a fair experience and are getting some help and have less pain!

 

I'm glad it wasn't too bad!

Just as an information though, endometriosis often isn't detectable in an ultrasound. You need a very well trained obgyn to catch it and even then there's no guarantee. The only way to be sure is a laparoscopy with taking samples.

Not to scare you, just to let you know if problems persist to keep that in mind.

 

My sister's endometriosis wasn't found until she had surgery.

 

Same for me.

There are different forms. Some have cysts, they are easy to see. As well as adenomyosis (endometriosis in the Uterus, thickens the wall), also some forms of rectovaginal endometriosis (under the cervix, visible with the eye even just using the speculum).

Some endometriosis grows very "flat" and into the organs (deep infiltrating). This is hard or impossible to see in ultrasound.

Just leaving that as general information in case anyone ever stumbles upon it.

No matter the cause, it's great that bio identical hormones work, @Sarah94 ! I've heard of several women with ME that use it.

 

Sorry to hijack, but thought I would report back for the next visitor - I had a TV ultrasound today, was relatively quick. It was only mildly painful when they pushed on my ovaries to look more closely at them, and because they are apparently polycystic.

I was dx PCOS, following 17 years of symptoms, but I have technically been 'treated' all that time with various contraceptive pills and devices, just without a known diagnosis, and suffered a huge amount of dismissal and disbelief along the way which may be the most traumatising part of it (although the migraines and pain are pretty horrific). I am yet to figure out how this links with the ME/CFS.