Many of us are familiar with abdominal ultrasounds: the cold gel, the wand being rubbed around on our torso, and the blurry images projected on the screen. While these are the more common ultrasounds typically performed, sometimes physicians need to order transvaginal ultrasounds for more detailed pictures — especially when it comes to our reproductive health and fertility. 

Rather than capturing images topically, transvaginal ultrasounds gather imaging using a probe inserted into the vaginal canal.

Also known as endovaginal ultrasounds, this procedure uses an ultrasound probe inserted about 2 to 3 inches into your vaginal canal. Using high-frequency sound waves, the probe is able to collect internal images of the pelvic organs, including your uterus, fallopian tubes, ovaries, cervix, and vagina.

technician preparing for a transvaginal ultrasound

These more detailed images allow physicians to better identify abnormalities and diagnose conditions like Polycystic Ovarian Syndrome (PCOS), Diminished Ovarian Reserve, and more. 

When are transvaginal ultrasounds used?

There are a number of reasons why your physician would order a transvaginal ultrasound as opposed to traditional abdominal ultrasound. 

According to the National Library of Medicine, your doctor might use this form of pelvic imaging to diagnose everything from unexplained vaginal bleeding to cysts, fibroids, polyps, or tumors. Transvaginal ultrasounds can be used to confirm an early pregnancy or diagnose an ectopic pregnancy. Additionally, your doctor may use an endovaginal ultrasound if you report experiencing pelvic pain, have had an abnormal pelvic or abdominal exam, or need the status of your IUD placement checked.  

If you are pregnant, your physician might use a transvaginal ultrasound to monitor the fetus’s heartbeat, examine your cervix for changes that could lead to miscarriage or premature delivery, and look at the placenta for abnormalities. Doctors might also use this form of pelvic imagining to find the source of any abnormal bleeding or diagnose a miscarriage.

technician putting a condom on a transvaginal ultrasound probe

Additionally, transvaginal ultrasounds are a common diagnostic tool used in in-vitro fertilization (IVF) procedures to monitor the growth and development of follicles in the ovaries. Follicles are the small sacs in the ovaries that contain eggs, and during an IVF or egg-freezing cycle, doctors aim to stimulate the ovaries to produce multiple follicles. The growth of these follicles is monitored via transvaginal ultrasound to ensure they are developing properly prior to egg retrieval. 

What can you expect during a transvaginal ultrasound?

Typically, a transvaginal ultrasound requires little preparation from you. Depending on the reason for the examination, you might be asked to either have a full or empty bladder. If you are asked to have a full bladder, you’ll be asked to drink 32 ounces of water, which helps lift your intestines, allowing the technician to get clearer images of your pelvic organs.

At your physician’s office, you’ll be asked to change into a hospital gown, and if you are menstruating, you’ll have to remove your tampon, disc, or cup if you have one in. 

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Just like any other pelvic examination, you’ll be asked to lie down on your back — you may or may not need to place your feet in stirrups.

doctor sharing ultrasound photos

Your doctor or ultrasound technician will cover the endovaginal ultrasound wand with a condom and lubricating gel before inserting it into your vagina. You might experience some pressure as the ultrasound wand is inserted, similar to the feeling of a speculum during a pap smear. But don't worry, a transvaginal ultrasound is not painful! 

The probe will then begin internally emitting sound waves, which will bounce off your intestines and create images of your pelvic cavity and organs. The probe may also be moved around a bit to gather more comprehensive pictures. 

If you are not pregnant and are receiving the transvaginal ultrasound for non-pregnancy-related images, you might have to have saline-infused sonography (SIS), also known as a saline sonogram. This type of ultrasound simply requires saline to be inserted into the uterus before the probe, so that it can help identify any potential uterine abnormalities. 

If you were unfamiliar with transvaginal ultrasounds prior to reading this, or perhaps are preparing yourself to begin fertility treatments, now you know. If your doctor or fertility team has ordered one for you, we hope having this knowledge and a clear set of expectations can help ease any anxieties you might have leading up to the procedure. Wishing you the best of luck! 

Brighid Flynn is a freelance writer based in Philadelphia where she lives with her husband and puppy. She is just beginning her journey toward motherhood.