Ep. 56: Advocating in the Dr.’s Office: Transvaginal Ultrasound

Welcome back to the Woven Well Podcast! 

Today we’re going to talk about transvaginal ultrasounds: what they are, what they do, and how you can make it as comfortable of an experience as possible! 

This is a part of an ongoing series we offer called Advocacy in the Doctor’s Office. Last year we had an episode that focused on how to Ask Good Questions in the Doctor’s Office. I’m thrilled that it was so helpful for so many women! In addition to the episdoe, we also included a written guide to help you feel prepared for your next appointment. If you’re interested in either, you can find those links in the show notes. 

We believe that advocacy is incredibly important. 

And here’s why: You were lovingly designed by the Creator of the Universe, with beauty and intention. You are worthy of the greatest respect, because you are a child of God. 

Not everyone in the world seems to understand this, though. They don’t always treat us with this respect, sometimes intentionally but most of the time unconsciously. How we advocate for ourselves can help us be treated with that dignity and care that we deserve. 

And so even though it can sometimes feel foreign to us to do that, it’s worth it!

Also, it makes experiences like a transvaginal ultrasound a whole lot more comfortable!  

So let’s talk about ultrasounds. What are they and why may your doctor request one? 

Ultrasounds, or sonograms, are a radiation-free way to get an image of somewhere inside of the body. Ultrasounds use sound waves to recreate the structure of a certain part of your body, like your uterus, fallopian tubes, and ovaries. It doesn’t show just still images, either, it gives the medical providers the opportunity to see a dynamic view of the organs as they move. They can see things like blood flow and they can measure things like a cyst or a pregnancy in three dimensions. 

Maybe we’re most familiar with the idea of an ultrasound or sonogram during pregnancy, and that’s a great example of when it’s used. An ultrasound allows you to see the growing baby, placenta, umbilical cord, and more. 

But there are lots of reasons your OBGYN may want you to have an ultrasound outside of pregnancy, for diagnostic reasons. If you’re having irregular bleeding, painful cysts, trouble ovulating, or suspected fibroids, an ultrasound is often the first step to diagnosing the reason. 

When an ultrasound of female reproductive organs are needed, a transvaginal ultrasound is usually the go-to. Instead of a wand moving across your stomach, a more narrow wand is guided through the vaginal opening. Because of this, it can be a little off putting when you find out your doctor would like you to have one. What will it be like? Should I be nervous? Do I really need one? 

And that last question is maybe an interesting one, because when your doctor tells you you need something done, of course most of the time, you do! But there is always space for you to consider your needs. I’ll give you this example: I have a client who had a history of medical trauma. Any type of procedure made her really anxious. When she saw her doctor, they recommended a transvaginal ultrasound, and so she asked the doctor how necessary the u/s was. Surprisingly, they said it wasn’t actually critical, they were just doing it as a precaution. They agreed to keep an eye on things and check in again in a few months if the problem persisted. There is always space for your comfort. Your needs should never be a hassle, and it’s always okay to ask questions. 

When it is time to have a transvaginal ultrasound, you can expect to see an ultrasound technician. This is typically a female, but if it’s not, and you prefer one, you can let them know. 

They’ll invite you into a small room that has a flat table, usually with stirrups like at a gynecological visit. There’s also a fairly large ultrasound machine. They’ll dim the lights, ask you to undress from the waist down, and provide you with a sheet or blanket to put across your legs. You should not need a full bladder for a transvaginal ultrasound, only a pelvic one.

When it’s time for the ultrasound, they’ll insert the wand through the vaginal opening and move it in various directions in order to get the needed images. They may be measuring uterine thickness, looking for uterine fibroids or polyps, ovarian cysts, or checking on ovulation. They can do all of those things and more in this type of ultrasound! 

How long it takes is usually dependent on how many things they’re evaluating, but I’d say you’re safe to assume 15-30 mins as a rough estimate. 

Now, there are lots of little things you can do during this experience to make it as comfortable for you as possible! 

And let me say this - so many of us worry that asking for things makes us a nuisance. 

You’re not a nuisance. 

A really good ultrasound tech may even tell you all the things I’m about to share themselves. But offices are busy, they don’t know you, and they could get skipped. Asking for them yourself helps you feel in control and have the best experience possible.

So here are just a few examples: 

Change where you feel comfortable. If they ask you to change in a room down the hall and then walk down that same hall in a gown or with a towel wrapped around you, and you don’t feel comfortable with that - ask to change in the room! That may not be their norm, but it’s a totally reasonable request. Not everyone will want to walk down the hall with only a sheet around them.

Once you’re undressed and on the table, lay back when you feel ready. They may leave you in the room to change, and you feel the expectation that you need to be laying back with feet in the stirrups by the time they come back in. They may even mention that. But it may take them a few minutes to get your paperwork and prepare the wand, and you’ll be in that position the whole time. It’s totally fine to just sit on the table until they say they’re ready, and then you can lay back. 

At this point, you definitely want to have let them know if you have any allergies or sensitivities to latex, KY Jelly, or anything else that they may use. If it’s not on your chart, they may not think to ask. Even if it is on your chart, it doesn’t hurt to confirm it verbally! You definitely don’t want to have an allergic reaction in that area if you can prevent it! And they should have alternatives available. 

Another tip is to ask to guide the wand in yourself. This is not an unusual request. In fact, you may have a tech who suggests this herself. But you can always ask to do this. 

It can be really helpful, too! It saves the hassle of the tech searching for the right spot, it maybe prevents that KY jelly from getting everywhere… but it’s also a great way to maintain control of the situation. There are lots of reasons why it may be unsettling to have someone else introduce the wand. By guiding it in yourself, you maintain control of what happens, when, and how. You have every right to ask for this. 

Once the ultrasound begins, it should be a painless experience. So if you’re ever uncomfortable, let them know. They don’t want you to be in pain, and it’s unusual to experience any. They may realize what happened and be able to immediately fix it. Maybe they’re moving the wand too quickly, and they can simply move it more slowly. 

If they are in a certain direction or something that’s causing the discomfort, ask them to pause and then ask how long that position is needed and how critical it is. Sometimes they just wanted a third angle on the same image and it’s not that critical. Other times it may be the main thing they’re there to look at. You can have a conversation with her about next steps. Worst case scenario, you can always stop the ultrasound for now and come back another day, if necessary. 

That’s the thing. Especially in this type of scenario, you always have the right to decide what happens to your body. 

I honestly expect your ultrasound experience to be easy and pain free. They are very routine procedures and can give us incredible information. But that doesn’t mean there may not be reasons why you’re nervous or uncomfortable, and what I want you to take away today is that your experience matters. Your comfort matters. Whether it’s with an ultrasound or any other medical procedure. 

So 9 times out of 10, you’ll have this easy, painless, simple experience. Using these tips, it really helps ensure you’re as comfortable as you can be. 

But if at any time you’d like the ultrasound to stop, say so. State it clearly, “Please stop: I’d like to end the ultrasound now, even though I realize it may not be complete.” Totally your right. 

Once the ultrasound is complete, they’ll gently remove the wand and you’ll have a moment to clean up. They often have towels or wet towelettes handy, but if you don’t see them or she doesn’t mention them, just ask what’s available. They shouldn’t ever leave you without anything. 

Again, an ultrasound should be a painless experience, so you shouldn’t experience spotting or pain afterward. If you are, certainly let your medical professional know. 

Before you leave, ask when you can expect results and who will discuss them with you. 

The ultrasound tech doesn’t read these images and they don’t speak with your doctor, so it won’t be that person, but they likely know who it is and what the process looks like. It can be helpful to have that expectation before you leave, so if you haven’t heard anything by their expected time, you’ll be able to follow up promptly. 

Ultrasounds are a standard, excellent tool in gynecological health. It’s pretty likely that you’ll have a transvaginal ultrasound at least a few times in your life, even if you are never pregnant. Feeling prepared can make a huge difference in your experience. And I hope today’s episode has helped you to feel that way! 

If you’d like a written form of all these tips, we’ve already got it ready for you! We have that available as a free resource on our website at wovenfertility.com/resources. I invite you to check it out. 

We’ll be posting about it on our Instagram page, as well: @wovenfertility.

You are so incredibly valuable. Who you are as a person and a woman can never be replicated. You are intimately known and loved by God, who designed you with beauty and intention. 

Your body matters. Your experience matters. Your comfort matters. 

I hope you feel these things deeply today. 

As always, thanks for listening as we continue to explore together what it means to be woven well.