• Sexual Health

Does a Transvaginal Ultrasound Hurt? Everything You Need to Know Before Your Appointment

Medically reviewed and edited by Tenae Griffin, NP

A transvaginal ultrasound can feel intimidating – especially if it's your first time. 

This powerful imaging tool provides essential insights into your reproductive health, helping to diagnose conditions like abnormal bleeding, pregnancy complications, or infertility issues. 

Unlike traditional ultrasounds, a transvaginal ultrasound offers a closer, more detailed look at your pelvic organs — all without the risks of radiation. 

In this article, we’ll guide you through what to expect during your first transvaginal ultrasound, so you can take charge of your health.

What is a Transvaginal Ultrasound?

A transvaginal ultrasound – much like other ultrasounds – allows healthcare providers to visualize internal organs without using harmful radiation. 

Ultrasound imaging uses a device called a probe, which is placed on the body to capture images of soft tissues, such as organs. 

However, in a transvaginal ultrasound, the probe is a long, plastic device that is inserted into the vagina to obtain a more detailed and closer view of the female reproductive organs. 

A transvaginal ultrasound is typically performed alongside the standard transabdominal ultrasound for a comprehensive assessment. 

While other imaging methods are available, an ultrasound is highly valuable due to its accessibility, affordability, and lack of radiation exposure. 

This makes it particularly useful in obstetrics, where protecting an unborn child from radiation is crucial.

How does an ultrasound work?

Ultrasound works by emitting sound waves into the body and measuring the waves that bounce back after hitting tissues and organs. 

As sound passes through tissues of varying densities and shapes, it changes direction, either penetrating deeper or reflecting back. 

These returning sound waves are then converted into an image, revealing the structures the waves encountered. 

This technology is similar to radar used by ships and planes, and it mirrors how animals like bats use echolocation to navigate their surroundings through sound.

Is a Transvaginal Ultrasound Painful?

Transvaginal ultrasounds are typically not painful, but they can cause physical and psychological stress. 

Always communicate with your healthcare provider if you feel uneasy or overexposed during the procedure. 

Some women may experience discomfort due to insufficient lubrication of the ultrasound probe. Water-based lubricants are commonly used to make the process more comfortable. 

Additionally, pain may occur if there is an undiagnosed pelvic issue – such as endometriosis or an ectopic pregnancy – which is common among women undergoing transvaginal ultrasounds. 

If you do experience pain, inform your healthcare provider immediately and follow their instructions on what to do next.

What can you expect from the procedure?

Your first transvaginal ultrasound can seem daunting, but here's a quick overview of what to expect on the day of your procedure:

• First, your doctor or healthcare provider will introduce themselves, take your medical history, and perform an examination. They may ask questions about your sexual history, too.

• Your ultrasound technician, radiographer, or doctor must obtain your informed consent before proceeding. Minors will need additional consent from their parents.

• If your healthcare provider is male, a chaperone will be present during your examination. You can request a chaperone anytime for any reason, and an ultrasound technician (ultrasonographer) may also request one.

• You may be asked to remove your clothing, put on a gown, and empty your bladder before the procedure. You will only need to expose the area necessary for the ultrasound.

• Next, you will be asked to lie down on your back and may be positioned in stirrups, placing your legs in the bent position known as the lithotomy position.

• An ultrasound probe, shaped like a long rod, is then covered with a protective sheath and lubricated.

• The probe is gently inserted into the vagina. While it’s not typically painful, you may feel some discomfort.

• The probe is moved around to capture images of the pelvic organs using sound waves, with the images displayed on a monitor in real-time.

• Once the procedure is complete, the probe is removed, the cover discarded, and the equipment sterilized.

Some minor bleeding may occur afterwards, but this is usually normal. If you experience any concerns or pelvic pain, inform your doctor immediately.

How should you prepare for a transvaginal ultrasound?

No specific preparation is usually needed, although this may vary depending on the reason for the ultrasound. 

You may be asked to empty your bladder before the procedure. If you're also having a transabdominal ultrasound, a full bladder is preferred because it helps lift and straighten the pelvic organs, shifting the uterus up and moving the bowel aside for improved imaging.

You can also request to bring a chaperone if you feel uncomfortable. The procedure won’t affect menstrual bleeding and can be performed during your period, though tampons will need to be removed.

You’ll typically be asked to complete paperwork and sign a consent form before the procedure.

When is a Transvaginal Ultrasound Performed?

Transvaginal ultrasound provides a clearer and deeper view of pelvic organs, which may not always be possible with a conventional transabdominal ultrasound. 

It is especially useful in cases where pregnancy makes other examinations risky due to the potential for fetal radiation exposure.

Here are seven reasons a transvaginal ultrasound may be necessary:

1. Evaluation is done to confirm pregnancy and diagnose potential issues, such as ectopic pregnancies (a medical emergency where the fetus develops outside the womb), developmental abnormalities in the fetus, and missed miscarriages.

2. Assessment of infertility, including diagnosing its cause and aiding fertility treatments like in vitro fertilization (IVF)  

3. In cases of obesity, where abdominal fat may prevent accurate imaging with traditional methods  

4. Evaluation of abnormal uterine bleeding, including irregular, absent, or heavy bleeding  

5. Assessment of abnormal pelvic organs

6. Diagnosis and evaluation of benign gynecologic lesions or cancers  

7. Checking for possible pelvic infections, such as pelvic inflammatory disease (PID)

Transvaginal Ultrasound vs. Abdominal Ultrasound

Transabdominal and transvaginal ultrasounds are both commonly used to assess pelvic and abdominal regions, each with specific indications. 

While transabdominal ultrasounds offer a wider view of the abdomen, transvaginal ultrasounds provide a more detailed look at the pelvic organs.

Detailed below are the main differences of these procedures:

*Bowel gas can interfere with the visibility of the pelvic organs during an ultrasound because sound waves travel differently through gas compared to liquids or solid tissues. This makes it challenging to obtain clear images in transabdominal ultrasounds, especially in individuals with extra gas.

Special Methods: Saline Infusion Sonography

Saline infusion sonography, also known as sonohysterography, is a special transvaginal ultrasound method used to evaluate and diagnose conditions in the uterus and fallopian tubes, such as polyps, fibroids, uterine scarring, masses, or cancer. 

It can also assess the patency (openness) of the fallopian tubes. 

The procedure involves inserting a catheter into the vagina and filling the womb with sterile saline, providing a clear view of the uterus and its lining. 

In some cases, air or contrast is also injected into the uterus to check if the fallopian tubes are open. This method is useful when you want a more detailed view of the uterine tubes.

What are the Risks Involved with Transvaginal Ultrasounds?

Transvaginal ultrasounds carry minimal risks, especially when compared to imaging methods that use ionizing radiation which can cause cancer, skin burns, and harm to developing fetuses.

Some potential side effects of transvaginal ultrasounds include:

• Minimal discharge following the procedure  

• Discomfort during and shortly after the ultrasound  

• Infections in rare cases. This risk is slightly higher with saline infusion sonography but remains low (approximately 0.95% chance).

What Happens After the Transvaginal Ultrasound?

Once you’ve had your ultrasound, the images will be sent to a radiologist and/or gynecologist for interpretation. 

Your healthcare provider will then schedule a consultation with you to discuss the results. 

In most cases, there is no need for special care after the procedure, and you can resume your normal activities right away. 

If any follow-up tests or treatments are required, your doctor will guide you through the next steps.

When Should I See a Doctor for a Transvaginal Ultrasound?

The decision to undergo a transvaginal ultrasound depends on your healthcare provider's recommendations and your specific needs. 

It is typically performed for the reasons we mentioned earlier in the article. 

Since this procedure is more invasive than a conventional diagnostic ultrasound, you should have a thorough discussion with your doctor to ensure it's the right choice for you.

Where Can I Learn More about Transvaginal Ultrasounds?

While LifeMD doesn’t offer transvaginal ultrasounds directly, we can assist you with any questions or concerns about abnormal vaginal bleeding, pregnancy, or other gynecological issues. 

Make your appointment today to take control of your health — all from the comfort of your own home.

Tenae Griffin, NP

Tenae has worked in healthcare for over 16 years and has been a Family Nurse Practitioner since 2018. Her diverse experience and expertise in various healthcare settings enables her to provide comprehensive care to patients with a wide range of health needs. Tenae values building strong relationships with her patients and is dedicated to providing high-quality, patient-centered care.

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