Transvaginal Ultrasound: Purpose, Procedure, and What to Expect

At Independent Physicians Medical Center (IPMC) in Northeast Philadelphia, we perform transvaginal ultrasounds with professionalism, privacy, and sensitivity in our comfortable outpatient facility.

What Is a Transvaginal Ultrasound?

A transvaginal ultrasound (also called an endovaginal ultrasound) uses a slender, specially designed transducer — sometimes called a wand — that is gently inserted into the vagina. From this closer position (just centimeters from the uterus and ovaries), the transducer sends and receives sound waves that create highly detailed real-time images of the pelvic structures.

The internal approach eliminates the interference that abdominal fat and bowel gas can cause during a standard abdominal pelvic ultrasound, resulting in much sharper images. This is especially beneficial for evaluating the endometrium (uterine lining), small ovarian cysts, and early pregnancies. The test uses no radiation and is considered very safe.

Why Would Your Doctor Order a Transvaginal Ultrasound?

This test is one of the most frequently ordered imaging studies in gynecology. Your doctor may recommend it to evaluate:

• Abnormal vaginal bleeding — including heavy periods, bleeding between periods, and postmenopausal bleeding. The ultrasound can measure the thickness of the endometrium and identify polyps, fibroids, or other causes
• Pelvic pain — to look for ovarian cysts, endometriosis, pelvic inflammatory disease, or other sources of discomfort
• Uterine fibroids — non-cancerous growths in or on the uterus that can cause heavy bleeding, pain, and pressure symptoms. Ultrasound maps their number, size, and location
• Ovarian cysts and masses — to determine whether a cyst is simple (fluid-filled and almost always benign), complex, or solid (which may require further evaluation)
• Endometrial polyps — small growths on the uterine lining that can cause abnormal bleeding
• Endometriosis and adenomyosis — conditions where tissue similar to the uterine lining grows in abnormal locations
• Infertility evaluation — assessing the uterus and ovaries as part of a fertility workup, monitoring follicle development during fertility treatment, and confirming ovulation
• Early pregnancy — confirming pregnancy location (uterine vs. ectopic), dating the pregnancy, checking for a heartbeat, and evaluating early complications like threatened miscarriage
• Ectopic pregnancy — a potentially dangerous condition where a pregnancy implants outside the uterus, most often in a fallopian tube
• IUD check — confirming that an intrauterine device is properly positioned
• Cervical evaluation — measuring cervical length during pregnancy to assess preterm birth risk
• Cancer screening and evaluation — assessing endometrial thickness and structure in women with risk factors for uterine cancer

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How to Prepare

Unlike an abdominal pelvic ultrasound (which requires a full bladder), a transvaginal ultrasound is typically performed with an empty bladder for maximum comfort and image clarity. You’ll be asked to use the restroom before the exam.

No fasting is required. You can eat, drink, and take your medications normally. Wear comfortable clothing that allows easy access for the exam — a two-piece outfit is ideal. You will not need to fully undress; you’ll remove clothing from the waist down and be covered with a drape for privacy.

What Happens During the Exam?

1. Positioning. You’ll lie on your back on an exam table with your feet in stirrups or on footrests and your knees bent — similar to a gynecological exam. A drape covers you for privacy.
2. Transducer preparation. The sonographer covers the slender transducer with a disposable protective sheath (similar to a condom) and applies a small amount of lubricating gel. The transducer is about the width of two fingers and is much smaller than a speculum.
3. Insertion and scanning. The sonographer gently inserts the transducer into the vagina. You may feel pressure, but the exam should not be painful. If you experience discomfort, let the sonographer know immediately. The transducer is moved gently to capture images from different angles, including views of the uterus, endometrium, both ovaries, and the surrounding pelvic area. The sonographer may gently press on your lower abdomen with their other hand to optimize views of certain structures.
4. Doppler assessment. Color and spectral Doppler may be used to evaluate blood flow to the ovaries, uterus, and any masses or cysts.
5. Duration. The exam typically takes 15 to 30 minutes.
6. Combined approach. In some cases, a transabdominal ultrasound (with a full bladder) may be performed first, followed by the transvaginal portion for more detailed views.

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Understanding Your Results

A board-certified radiologist will review all images and measurements, including uterine size and shape, endometrial thickness and pattern, ovarian size and the presence of any cysts or masses, any fibroids (number, size, and location), and blood flow patterns. The report is sent to your referring doctor, who will explain the findings and discuss any recommended follow-up.

Normal endometrial thickness varies with the menstrual cycle and menopausal status. In premenopausal women, normal thickness ranges from about 4 mm to 14 mm depending on the cycle phase. In postmenopausal women, thickness greater than 4-5 mm may warrant further evaluation, especially if bleeding is present.

Ovarian cysts are extremely common and usually benign. Simple cysts (thin-walled, fluid-filled) almost always resolve on their own. Complex cysts with internal debris, thick walls, or solid components may need follow-up imaging or further evaluation.

After Your Transvaginal Ultrasound

You can resume all normal activities immediately, including work, exercise, and sexual activity. There is no recovery time. You may notice a small amount of lubricant when you use the restroom afterward — this is normal.

Results are typically available within 24 to 48 hours. Your doctor will contact you to discuss the findings and any recommended next steps.