The Transvaginal Ultrasound
More often, doctors request higher-resolution images, the kind that can be obtained with a transvaginal ultrasound. It may sound daunting, but it's not so bad. The transvaginal ultrasound is performed with a small, very thin, sometimes chilly transducer that is covered and lubricated. If you're allergic to latex, be sure to mention it to the technician before the exam so that a latex-free cover is used.
During the exam, the technician inserts the tip of the transducer two or three inches into the vagina, then captures images from different orientations. Although you may find yourself wishing you were on a beach somewhere instead of in stirrups, the procedure is not painful. Most women, in fact, find that it's easier than a Pap smear, and when it's over, it's over.
Although it's less common, your doctor might want a detailed sonogram of the inside of your uterus, in which case, a hysterosonogram (or sonohystogram) may be performed. Usually, this technique is reserved for investigating possible uterine abnormalities, including adhesions, polyps, and cysts, particularly after multiple miscarriages.
A hysterosonogram is typically scheduled one week after menstruation. The test begins with a transvaginal ultrasound, after which a speculum is inserted, the cervix cleaned, and a small, lightweight tube (catheter) introduced into the uterus. The speculum is then removed and the transducer re-inserted. The technician uses the catheter to fill the uterus with sterile saline solution that enables the doctor to see the topography of your uterus more readily. If your doctor has requested information about your blood flow, the technician will use Doppler ultrasound during the same exam; Doppler is performed using the same transducer, so you won't notice any difference.
Overall, the hysterosonogram is somewhat uncomfortable, like a gynecological exam, and you may experience some cramping associated with the use of the saline solution. Your doctor may ask you to take ibuprofen or acetaminophen before or after the exam, and sometimes doctors prescribe antibiotics to guard against infection.