Adenomyosis · Endometriosis · Tips

Internal Ultrasounds

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The internal.  The dreaded internal ultrasound.  It comes as part of your gynaecology appointment as part of the assessment of your reproductive organs but is notoriously surrounded by horror stories, embarrassment and is often associated with pain.

First things first, you don’t actually have to consent to having one done.  And if you choose to go ahead,  there will often be a chaperone present (or perhaps a family member of yours), but if not you can always choose to have one.

Ultrasound is a form of diagnostic imaging that using sound waves to produce a picture of the insides of the body.  Aside from internal ones, it is generally non-invasive and does not pose any risk with regards radiation.  It is simple and easy to access, and doesn’t require any preparation (aside from maybe having a full bladder or emptying it).  Ultrasound is limited to what it can detect and see.  For example, it tends to pick up swelling and soft tissue injuries easier than bony problems or chronic conditions like Endometriosis.

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Internal ultrasounds are a vital part of the gynaecology assessment, so patients are often encouraged to have them done.  They sometimes come as part of a more global assessment at a hospital sonography department where they might be trying to get to the bottom of your symptoms, for example, and of course they come with pregnancy too.  So for us women, it is hard to escape them, but think of them like smear tests – so important, over in a short space of time, and the person doing the test will make it as comfortable as possible.

Most of the time the gynaecologist at your appointment will be the one to carry out the ultrasound, and in my experience they are much better at interpreting specific gynaecology ones that a general sonographer.  However, if it is a general sonographer who is doing it don’t worry – all medical imaging is reported on by a senior, and often passed for a second opinion anyway.

Internal ultrasounds may come with a more comfortable transabdominal scan – as simple as having some cold jelly on your stomach and the sonographer pressing down slightly on your abdomen and pelvis to have a look on a screen that very much looks like TV static (I once went on a course as part of my diagnostic imaging development for my physiotherapy career, and we covered some ultrasound – despite the excellent teaching I really struggle to look at them and give a load of credit to those that can).  It’s the transvaginal part that is more intimidating.

It involves a penis-shaped device covered in a flimsy condom-looking thing being inserted inside your vagina.  It’ll be covered in lubricant and whilst it may look and feel like the gynaecologist is having a good ol’ rummage, they are simply trying to locate the basic female reproductive organs, so bear with them.

During the examination, you’ll probably find some awkward conversation trying to happen but the team are only trying to make it more comfortable for you.  And if at any point it hurts, feels uncomfortable or you want it to stop – you simply have to say.

With the internal ultrasounds I have had, whilst they are been quite painful (more on that to follow), I have found a good distraction in being shown and taught about what they are looking at.  Part of this is simply the Physio inside me liking medical imaging, but it really is a good distraction.  My consultants and any sonographer I have had have always taken to this and gone through things and the images in detail.  I’ve seen what my ovaries look like, what my cysts have looked like, what my lining looks like – you name it!  But its completely taken my mind off the poking and prodding.

For those of us with gynaecology conditions like Endometriosis and Adenomyosis, the person doing the examination will already know it might be painful for you, and will often help you find the best position to ease this.  For me, my left ovary is incredibly painful when touched with the ultrasound device, and when my gynaecologist was locating my cyst ruptures I could of hit the ceiling, but it was kind of worth it to get an answer.

When it comes to them being painful, remember that the Endometriosis growth location or cysts or phase of your menstrual cycle will have an impact.  Conditions like Endometriosis and Adenomyosis involve a lot of inflammation, so having something irritating this further will likely cause discomfort and pain.  Our insides are likely to be a lot more alert to pain too (read this article about that).

If you are facing an internal ultrasound soon, or want to know how to make the next one a bit more comfortable, I’ve got some tips below!

  • Be comfortable with the idea of having it done.  Like I mentioned above, you don’t have to consent to it and you can ask for a chaperone
  • Do what it takes to make it comfortable for you – nice underwear, shaving or waxing, whatever makes you feel ok
  • If it’s a person you don’t know doing the scan, make them aware of either any gynaecology conditions you have or how painful it might have been last time – if you don’t tell them, they can’t help
  • If something is hurting whilst they are carrying out the ultrasound, let them know – this not only might help them determine what it going on inside, but like above, if they don’t know they can’t help
  • If it’s becoming too much, tell them to stop.  You can have as many breathers as you like!
  • Speaking of breathing, taking deep breathing or practicing yoga-style breathing will help you and your pelvic floor muscles relax
  • Think of a good distraction technique – this could be talking to them, counting in your head or practicing mindfulness.
  • Follow the instructions on the letter.  For example, if you need to have a full bladder, as this will make the scan go easier
  • If its more the insertion of the internal scanning device that is or has caused problems, make sure you ask for more lubrication
  • Take your time to get up and dressed afterward, as it may feel sore or you might feel a bit lightheaded from lying down
  • If your ultrasound scan doesn’t reveal any cause for symptoms you may be experiencing, or give you a diagnosis, don’t worry – remember, ultrasound can’t detect some of the things that MRI or CT scans can
  • If it is has been done at your gynaecologist appointment, you’ll often get the results there and then
  • If it has been done at a hospital imaging department, you are most likely to have the report sent to your GP rather than there and then, as some NHS trusts are not allowed to tell you results there and then, due to the fact they often are interpreted by a senior member of staff.

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