An internal, or transvaginal, ultrasound (TVUS) uses a slender probe inserted into the vagina to create detailed images of the reproductive organs. While generally well-tolerated, many people find the scan uncomfortable or painful. It is important to distinguish between the expected sensation of pressure and true, sharp pain, as the latter often suggests an underlying medical issue or procedural factor.
Expected Sensations and True Pain
A transvaginal ultrasound introduces an object and movement into a sensitive area. Patients should expect to feel a sensation of fullness or deep pressure, especially when the sonographer angles the probe to visualize the ovaries and uterus. This pressure is normal because the organs are nudged into the correct viewing plane. The probe’s physical dimensions, typically covered and well-lubricated, are comparable to a large tampon.
True pain is characterized by a sharp, stabbing, or burning sensation, or cramping severe enough to cause nausea. This signifies that the probe’s movement is irritating tissue that is already inflamed or hypersensitive. The internal reproductive organs, particularly the ovaries, respond strongly to unexpected pressure when a medical issue is present. Normal pressure should be momentarily uncomfortable but should not linger or escalate to a level requiring the procedure to be stopped.
Underlying Conditions That Increase Sensitivity
If probe pressure immediately translates into severe pain, it often points toward a pre-existing condition that has made the pelvic organs hypersensitive. Endometriosis is a common culprit, where tissue similar to the uterine lining forms painful adhesions and cysts outside the uterus. The movement of the probe can directly press on these tender growths, causing significant discomfort.
Uterine fibroids, which are non-cancerous growths, can cause localized pain if they are large or positioned where the probe presses against them. Similarly, an ovarian cyst, especially if large, bleeding, or torsed (twisted), will cause acute pain upon contact. The pressure necessary for imaging is often enough to trigger a painful response from the tender sac.
Pelvic inflammatory disease (PID) can leave scar tissue and inflammation around the fallopian tubes and ovaries, making the pelvic cavity tender and reactive to the ultrasound. Conditions like vaginismus, involving involuntary tightening of the pelvic floor muscles, can cause intense pain at the vaginal entrance upon insertion. This muscle tension complicates the procedure and can be heightened by anxiety or a history of painful examinations.
Technical and Preparation Factors
Not all pain during a TVUS is caused by internal pathology; sometimes, discomfort relates to controllable procedural factors. Insufficient application of lubricating gel is a common cause of pain upon insertion, leading to friction that can feel like burning or scraping. The angle and speed of the probe insertion and movement also affect the patient’s experience.
When the technician is rushed or uses an abrupt technique, the sudden displacement of organs or rapid stretching of the vaginal canal can cause sharp pain. Patient anxiety is another factor, as fear of the procedure can cause a reflexive tensing of the pelvic floor and vaginal muscles. This involuntary clenching narrows the passage, turning insertion into a painful struggle against muscle resistance.
Effective communication between the patient and the sonographer is paramount. If discomfort arises, the scan should be paused to prevent a sustained painful experience. The physical dimensions of the probe can also be a factor, as some facilities may use larger probes or the patient’s anatomy may be more sensitive or narrower.
Indicators That Require Follow-Up
While mild pressure or spotting immediately after a TVUS is usually benign, certain indicators suggest a need for urgent medical follow-up. Severe pain that persists and worsens hours after the scan is a red flag, potentially indicating irritation of a pre-existing condition or a complication. Any occurrence of a fever or chills following the procedure could suggest the development of an infection, such as an exacerbation of pelvic inflammatory disease.
Unusual or heavy vaginal bleeding beyond light spotting, or the presence of a foul-smelling discharge, should prompt a call to your healthcare provider. These symptoms are not typical post-procedure effects and warrant immediate investigation.
For future procedures, patients can advocate for their comfort by requesting the smallest available probe and generous lubrication. Communicating anxiety levels beforehand can also be helpful. It is always acceptable to ask the sonographer to slow down or stop the procedure if the pain becomes intolerable.