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Trans-vaginal ultrasound – novel female imaging

Ultrasound imaging involves exposing part of the body to high frequency sound waves to produce pictures of the inside of the body. This is the same principle involved in the sonar used by bats, ships and fishermen. When a sound wave strikes an object, it echoes back. By measuring these echo waves it is possible to determine how far away the object is and its size, shape, and consistency.

In medicine, ultrasound is used to detect changes in appearance of organs, tissues and vessels, or detect abnormal masses, such as tumors. The idea of using ultrasound in medicine was borrowed from sonar technology, which makes use of sound waves to detect underwater objects. Ultrasound scanning in womens’ care has been around for several decades. Technological developments have delivered modern ultrasound machines with improved portability and resolution. We are now capable of seeing minute details in the female genital tract.

One development that stands out is transvaginal ultrasound (TVS). In this imaging technique, a vaginal ultrasound probe (called a transducer) is gently inserted in the vagina, and advanced close to the cervix. The probe is then moved from side to side, capturing detailed live views of the pelvic organs.

Almost every woman can have a TVS. It’s not advisable in virgins, and may be more uncomfortable in menopausal women. The experience is comparable to having a Pap smear, but most women find it easier as modern ultrasound probes are quite small compared to speculums used in doing Pap smears.

TVS is mostly applicable in Gynecological and early pregnancy ultrasound imaging. The image clarity and resolution is able to provide detailed studies of the uterus, cervix, ovaries and other pelvic structures. We are able to diagnose various diseases with unprecedented accuracy, including: ovarian cysts and tumors, uterine tumors and fibroids, causes of abnormal bleeding or pelvic pain, fertility problems etc.

In early pregnancy, TVS is the preferred imaging modality. Using this tool, we are able to confidently diagnose early pregnancy problems like miscarriages, and even diagnose ectopic pregnancies long before they rupture, thereby reducing risks to women.

The safety of TVS is well established. The technique uses sound waves well beyond human perception to create images that are processed by a computer and displayed on a monitor. There is no radiation exposure as is the case with conventional X-ray imaging, and so far, there are no known harmful effects of ultrasound in humans.

TVS must be carried out by trained and certified personnel. As with other medical procedures, individuals not trained and certified may make wrong interpretations following TVS, and thereby give inappropriate advice. Some Gynecologists have done training in TVS, and may be best placed to do the scan themselves.

When patients come for a TVS, they are asked to pass urine in order to keep the bladder empty. They then undress from the waist down, and are provided with an examination gown. The TVS probe is then cleaned with an antiseptic, and a cover (like a condom) is put in place and lubricated with ultrasound gel. The cover is changed with each patient. The patient is then positioned comfortably and the probe gently inserted in the vagina. Patients can view live images on the monitor as the scan is being done. The results are usually instant.

In some cases, similar imaging can be done via the back passage (rectum). This is called transrectal ultrasound, and is commonly done in men to image the prostate gland among other organs.

Most health units now offer TVS for diagnostic purposes. The cost is equivalent to conventional abdominal ultrasound, and sometimes the two are done at the same sitting. It is now almost routine for most pelvic imaging to be done transvaginally.

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