NOT ALL TRANSVAGINAL ULTRASOUNDS ARE EQUAL

Dr Steven R. Goldstein
Gynecologist in NYC

Most of my patients are aware that I use vaginal sonograms as part of the overall evaluation of gynecologic care and maintaining gynecologic health. However, increasingly I have become aware that there are many women who are now demanding a vaginal sonogram of their healthcare provider. More and more educated, intelligent women have come to realize that the traditional bimanual examination, with two fingers in the vagina and a hand on the lower abdomen for palpation, is extremely ineffective at detecting early changes that might, indeed, be ominous, if not lethal. Thus, many women are asking for periodic vaginal sonograms.

Most of the time such procedures are then referred to radiology for performance. A technician (preferred term “sonographer”), then performs the vaginal sonogram. They may take 50, 60, 70 or more still images of various anatomic structures, label them, and even write an initial report. Later, a radiologist will come by and “read” the images and finalize “the report.” Unfortunately, in some instances, the physician will merely sign off on what the sonographer has written. More competent radiologists will read the images themselves and only use the sonographer’s impression as a springboard. However, this is still now being read off of static images. This loses much of the advantage of vaginal sonograms.

I have championed the concept of “dynamic ultrasound”. This is one in which the patient is examined with the probe to see if there is any pain, to see if the pelvic organs have normal mobility, and that there is no scar tissue or adhesions. There is much more to a vaginal sonogram than simply the anatomy. For instance, sometimes an ovary will look normal, but not be in its normal anatomic location because of some scar tissue either from previous surgery or infection. Such patients may or may not have pain. Some such patients who desire fertility may have compromised fertility that would go otherwise unrecognized and simply delay their ultimate diagnosis and treatment.

Only in the US and Australia are most vaginal sonograms performed by technicians. I perform the examination myself routinely. Sometimes I am asked if a copy of the study can be sent elsewhere. I reply that the study was actually going on in my head while I was performing the examination and, while a sample of representative still images are kept for measurements for the chart, these do not constitute the actual study. That is performed in real time by me.

Vaginal sonograms are operator dependent and equipment dependent. It is not like having a blood test where, if the machine is calibrated, the result will be standard regardless of where it is done. Too many patients will say “I had a vaginal sonogram” thinking it is as standard and reliable as if they had a blood test. In my writing and teaching I am trying to spread the word to those who perform vaginal sonograms, be they physicians or technicians, that it needs to be done in such a dynamic fashion with movement of the probe, and the other hand on the lower abdomen. Then it really becomes an examination with ultrasound not simply an ultrasound examination.

If you are interested in having a thorough gynecological exam, including a transvaginal ultrasound, then a consultation with Dr Steven R. Goldstein, a leading NYC Gyn may be in order.