Gender medicine, the importance of transvaginal ultrasound

By Cristiano Antonino On May 16, 2023

Transvaginal ultrasound is a very common non-invasive gynecological diagnostic-instrumental examination. It can be two-dimensional or three-dimensional, it is usually associated with the gynecological visit and allows to evaluate the internal reproductive organs and the surrounding organs through a probe positioned in the vagina

First used to detect malformations of the uterus, transvaginal ultrasound is now essential for identifying and diagnosing various disorders and pathologies.

What is transvaginal ultrasound used for?

Transvaginal ultrasound is a particularly useful exam because it allows you to safely and quickly observe the uterus, ovaries and fallopian tubes (or salpinges), as well as the surrounding organs, such as the bladder, ureters, rectum and sigmoid colon.

This is why in daily practice the gynecological ultrasound examination has many indications today:

in the diagnostic process of neoformations or malformations suspected on anamnestic and objective basis of the genital organs;
in the diagnostic process of women suffering from chronic pelvic pain or dysfunctional pathologies (irregular menstrual cycle) or infectious processes that may affect the internal genitalia;
in the differential diagnosis with other abdominopelvic pathologies in emergency conditions (appendicitis, diverticulitis, colitis);
in the diagnostic process of peri- and post-menopausal patients with atypical bleeding, helping to determine the characteristics of the endometrium and the uterine cavity (suspicions of endometrial neoplasms or research for polyps);
in the surveillance of the ovaries and endometrium in women with genetic predisposition to ovarian cancer or familial syndromes for tumors (BRCA mutated and/or affected by Lynch Syndrome);
in the diagnostic processes of infertility (diagnosis, monitoring and assistance with assisted reproduction techniques);
in the monitoring of medical therapies (tamoxifen or hormonal therapies), in the control of surgical outcomes (after myomectomies) and in the diagnostic process of patients affected by pelvic static pathology (urinary incontinence, severe constipation).

How is transvaginal ultrasound performed?

Transvaginal ultrasound is based on the action of sound waves and is neither dangerous nor painful for the patient.

In fact, the examination usually takes place at the same time as the gynecological visit (unless there have been other indications from the specialist), using a probe capable of emitting high-frequency ultrasound inserted inside the patient’s vagina, lying on the couch in the gynecological position.

The sound waves emitted by the probe are reflected by the internal organs and reworked as images on the ultrasound monitor, thus allowing the specialist to evaluate the state of the areas of interest.

Transvaginal ultrasound and menstruation or sexual activity

Transvaginal ultrasound can be performed at any time, even in the presence of menstrual flow, on patients who have already started sexual activity, it cannot be performed if the patient has never had sexual intercourse.

In this case, it is preferable to subject the patient to transabdominal ultrasound with a full bladder, which in any case allows good observation and monitoring of the same pathologies.

Transvaginal ultrasound in pregnancy: can it be dangerous?

Absolutely not: transvaginal ultrasound, in fact, is commonly used in the first weeks of gestation to observe the embryo and correctly date the pregnancy itself (while later, transabdominal ultrasound offers better images) and to perform cervicometry (i.e. measurement of the length of the neck of the uterus), essential for monitoring the risk of a miscarriage in the first trimester of pregnancy.

In cases of blood loss it is used to assess the risk of abortion or identify an abortion in progress.

First and second level transvaginal ultrasound: what are the differences

Transvaginal ultrasound can be first or second level:

The first level transvaginal ultrasound is simultaneous to the gynecological examination and is used to identify the presence of any conditions or pathologies. This may need to be followed by a second-level transvaginal ultrasound, which can provide the specialist with more precise information on the element being sought.
The second level transvaginal ultrasound is therefore requested as an in-depth analysis following the gynecological visit and the first level ultrasound, when there is a suspicion of a pathology that requires further checks and takes place with different times and methods. In fact, it must be performed by evaluating very specific parameters (vascular blood flows, color and/or power Doppler signals, in-depth measurements of specific details in the internal genital organs examined), often in association with the evaluation of certain blood chemistry values (dosage of tumor markers) by properly trained personnel. internationally trained and certified.

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