Transvaginal Ultrasound Form

A transvaginal ultrasound is an optional procedure performed with an ultrasound transducer inserted into the vaginal canal. Generally, higher resolution images are obtained the closer the ultrasound transducer is to a structure of interest. This examination often provides more detailed images which may aid in the diagnosis.

Gynaecological ultrasound and some early pregnancy ultrasound scans are routinely performed using a transvaginal probe technique. There is no clinical risk associated with performing a transvaginal ultrasound scan. Transvaginal ultrasound scans can safely be performed during menstruation and episodes of vaginal bleeding. Please note that we use Surgi-gel lubrication for Transvaginal ultrasound scans.

You are under no obligation to have this examination performed and it will only be performed with your consent.

• If at any stage during the examination, you feel uncomfortable or do not wish to continue, please let the doctor know and the examination will be terminated immediately.
• If you have any questions or concerns; please address the doctor prior to or during the examination.

The procedure has been explained to me; I understand the following:

• Strict sterile technique will be enforced.
• The ultrasound transducer will be inserted into my vagina.
• The doctor will move the transducer up and down during the procedure to obtain the required images.
• I may request a third party to be present during the examination to act as a chaperone.
• I may request for the examination be stopped at any time during the procedure.
• This examination may not always provide better image quality.