Author: Huang Xin (Beijing Tsinghua Changgeng Hospital)
Patients with menstrual abnormalities, abdominal pain, abdominal discomfort, pelvic masses, post-tumor surgery, routine physical examination, and patients requiring IUD localization require examination at the gynecological clinic.
After completing the gynecological examination, the doctor will generally open an ultrasound application form, and some patients will wonder, how is the gynecological ultrasound examined? What do I need to do before the test?
Below we break down several ways to perform a gynecological ultrasound; how the different tests are done; whether there is pain or not, and what the patient needs to do before the test.
1. Transabdominal ultrasound
The scanning range is wide, and the scanning surface and angle are flexible, which can completely present the whole picture of the tissue organs in the pelvic cavity.
Image source: Tencent Medical Code
1. Prepare before inspection
Patients will be asked to fill the bladder moderately.
Objective: A full bladder can push away the intestinal tubes that obscure the uterus and bilateral appendages, and the urine in the bladder can be used as a good sound leakage window, and the organs behind it are more clearly presented to the examiner.
Method: Before the examination, the patient drank 500 to 700 ml of water or a drink, waited for 30 to 60 minutes, the summer weather was hot, the patient was prone to sweating, you can drink more water appropriately, wait patiently.
For patients with acute illness, renal insufficiency and the elderly who are unable to hold urine, they can be routinely sterilized and then inserted with a catheter and injected with about 500 ml of normal saline.
Criteria: The patient has a more obvious urinary intention, and a slight bulge in the lower abdomen is sufficient.
The effect of filling degree on the image: an overfilled bladder will cause the pelvic organs to be pushed backwards, pressurized, and deformed, and the organs that need to be observed will distort the image due to distance; the measurement data will be inaccurate due to structural deformation; and even the mass in the adnexal area may also be pushed and obscured, missed and misdiagnosed.
When the bladder is poorly filled, the pelvic organs are not fully exposed and fully visualized, which may lead to missed and misdiagnosed.
2. Inspection method
The patient lies on his back on the examination bed with his legs outstretched and appropriately close to the doctor. After applying an appropriate amount of couplant to the local skin, the probe is placed on the surface of the lower abdomen for scanning.
The probe constantly changes the scan site from left to right, top to bottom, and when it encounters areas that need to be focused, it constantly changes the angle and section, and even pressurizes it to get the best display image.
3. Patient feelings
There will be no obvious discomfort in the examination itself, but the preparation before the examination is time-consuming and laborious. Patients often linger at the door of the examination room, not knowing whether they have met the doctor's examination requirements and worrying that if the bladder is overfilled, it will affect the effectiveness of the examination.
For patients with early pregnancy reactions and old age and infirmity, holding urine is a difficult and painful task, and it is necessary to prepare psychologically in advance.
2. Transvaginal ultrasound
This is by far the most important gynecological ultrasound, as the probe is placed close to the pelvic organs, resulting in sharper images and a more nuanced understanding of structures and features.
note! Only women who have sex should have this test.
Patients need to empty the bladder.
The patient removes the panties, takes the bladder amputation stone position (lying on his back, bending his knees, feet on both sides of the examination bed and parted on both sides, and the heels of both feet as close as possible to the buttocks), the doctor disinfects the condom on the vaginal probe jacket, applies a small amount of sterile couplant inside and outside the sleeve, and then gently inserts it into the patient's vagina, with the top of the probe reaching the vaginal dome or uterine neck.
Depending on the position of the target organ, the probe will also be scanned continuously from front to back, left to right, and if the uterine flexion is obvious and cannot be fully scanned, the doctor will ask the patient to raise the hip to cooperate with the examination.
Sometimes in order to obtain better image quality in the target area, the doctor will use the left hand to press the patient's lower abdomen with a probe scan.
Most young women have a certain psychological fear of transvaginal ultrasound, and instinctive tension will increase the discomfort of the examination, and generally after the comfort and persuasion of the doctor, the examination can be successfully completed.
With complete understanding and relaxation, this test does not increase the patient's discomfort at all.
Many elderly women will also resist transvaginal ultrasonography because the vagina is relatively dry, at this time, the examiner will apply some couplant to the condom of the probe to play a more lubricating role, which can greatly reduce the patient's discomfort.
3. Transrectal ultrasound
Often used in patients with blurred transabdominal exploration images but not suitable for transvaginal examination (such as women without sexual life), it is an unconventional and complementary examination method in gynecology, and the examination probe can also be used transvaginal probe.
Patients need to empty large, urine beforehand.
Patients can use bladder amputation stone position; can also be left lying position, left leg straight, right leg flexion, right knee as close as possible to the chest, the examiner will be on the probe coat 1 to 2 condoms, and the condom coat is applied to the appropriate amount of couplant to play a lubricating role, instructing the patient to relax the anus after gently inserting the probe into the rectum, and finally transform the position into a bladder amputation stone position.
The scanning method is similar to that of transvaginal ultrasound, and the image quality is slightly inferior to that of transvaginal ultrasound.
Even if the examiner speaks comfortingly and moves softly, the patient will still have a more obvious feeling of discomfort, but sometimes for a more definitive diagnosis, the patient is generally acceptable.
4. Ultrasound of the perineum
At present, it is widely used in the diagnosis of pelvic floor dysfunction (such as urinary incontinence, pelvic organ prolapse, etc.), the selection of treatment options and post-treatment follow-up.
Transperineal ultrasonography can be used in almost all patients associated with urinary incontinence and organ prolapse, including pelvic floor function assessment after pregnancy and childbirth; stressful and urgent urinary incontinence; leakage and dysuria; fecal incontinence and defecation disorders; pelvic organ prolapse.
Transperineal ultrasound can also be used to diagnose lower vaginal lesions such as lower vaginal tumors and endometriosis lesions, but because the lesion location is low, gynecologists can observe with the naked eye and directly take pathological tests, so they have rarely been used in clinical practice.
Patients should empty large and urine before examination.
Patients are given bladder amputations, and if necessary, they can change their position as prescribed by their doctor, and a volumetric probe, known as a three-dimensional probe, is used for examination.
The examiner applies an appropriate amount of couplant to the surface of the probe, a sterile probe sleeve for the outer cover, and more couplant on the outside of the probe sleeve to press the probe against the patient's vulva.
According to the guidance of the doctor, patients should do the maximum Valsava movement (that is, the action of holding the breath and pressing down the abdomen) and the contraction action (the contraction of the pelvic floor muscles).
The examiner observes pelvic organ movements, levator ani muscle contraction, and the integrity of levator ani and sphincters.
Because the examination is done outside the body, the examination itself is not painful. Sometimes because it is necessary to cooperate with the examiner to do the corresponding actions, if there is no adequate communication or understanding in advance, some patients will feel that the examination is more complicated.
If the action cannot be accurately completed according to the doctor's orders, then the test results may be different from the real condition. Therefore, if you have any doubts during the process, please consult the doctor in time.
5. Summary
In short, patients should trust their doctor when choosing an ultrasound modality, and the doctor will choose the one that works best for you.
Before the examination, the patient needs to have an understanding of the examination and make appropriate physiological and psychological preparations, so as to relieve tension, better cooperate with the ultrasound doctor's examination work, and get more accurate results.
*The content of this article is a popularization of health knowledge and cannot be used as a specific diagnosis and treatment recommendation, nor is it a substitute for face-to-face consultation by a practicing physician, for reference only.
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