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Radiology • Gynaecological Ultrasound

Pelvic Ultrasound

Also called: USG Pelvis • Transabdominal Scan • Transvaginal Ultrasound (TVS)

Pelvic ultrasound uses sound waves to examine the uterus, endometrium, ovaries, adnexa and surrounding pelvic structures. It can investigate pain, abnormal bleeding, a suspected mass or a known condition.

An external scan provides an overview through a full bladder. An internal transvaginal scan can provide closer, higher-detail views and is performed only after explanation and consent.

Book a Scan How to prepare ↓

A scheduled scan is not emergency care

Seek Urgent Assessment for Severe Pelvic Symptoms

Do not wait for a routine ultrasound appointment if you have:

  • Sudden severe lower-abdominal or pelvic pain, especially with vomiting or faintness.
  • Pelvic pain with a positive pregnancy test, missed period, vaginal bleeding, dizziness or shoulder-tip pain.
  • Very heavy bleeding with weakness, breathlessness, racing heartbeat, dizziness or collapse.
  • Severe pelvic pain with fever, shaking chills, persistent vomiting or marked illness.
  • Rapidly worsening abdominal swelling, severe tenderness or inability to pass urine.
  • Severe pain following fertility treatment, a pelvic procedure or recent surgery.

Emergency assessment may require examination, pregnancy testing, blood tests and urgent imaging. Conditions such as ectopic pregnancy, ovarian torsion, a ruptured or bleeding cyst and severe infection cannot safely wait for a routine appointment.

What is a Pelvic Ultrasound?

Ultrasound creates real-time images from high-frequency sound waves. A pelvic examination may use a probe over the lower abdomen, a slim internal probe placed within the vagina, or both. Neither method uses X-rays or ionising radiation.

The external and internal routes are complementary rather than competing tests. The external scan shows the wider pelvis through the fluid-filled bladder, while the internal scan places the probe closer to the uterus and ovaries for greater detail.

An Internal Scan is Always Your Choice

The radiologist explains why a transvaginal scan may help and what it involves. It proceeds only with your consent. You may decline, ask questions, request a pause or stop the examination at any time. An external scan or another investigation can then be discussed, although it may provide less detail.

External and Internal Pelvic Scans

Transabdominal pelvic ultrasound A probe moves over gel on the lower abdomen. A comfortably full bladder creates an acoustic window and moves bowel aside, helping show the uterus, ovaries and wider pelvis.
Transvaginal ultrasound (TVS) A slim, covered and lubricated ultrasound probe is gently placed within the vagina—not the cervix or uterus. The empty bladder allows close, high-resolution views of pelvic organs.
Combined examination Many appointments begin with the external scan. You can then empty your bladder before an internal scan is offered for additional detail.
External-only examination Used when an internal scan is declined or not clinically appropriate. The report may state if assessment is limited by organ depth, bowel gas, bladder filling or other factors.
Other specialised examinations Doppler, saline sonography, transrectal scanning or three-dimensional ultrasound may be used for selected questions. They are not automatically part of a routine pelvic scan.

Tell the booking team if you have never been sexually active, have difficulty with internal examinations, have experienced trauma, have pelvic surgery or narrowing, or do not want an internal scan. This allows the examination and support to be planned respectfully.

Why Might Pelvic Ultrasound Be Requested?

Pelvic pain Acute, recurring or persistent lower-abdominal discomfort requiring structural assessment.
Abnormal bleeding Heavy, irregular, prolonged, intermenstrual or postmenopausal bleeding.
Pelvic fullness or bloating A palpable mass, increasing abdominal size, pressure or persistent bloating.
Known condition follow-up Fibroids, ovarian cysts, endometriosis-related findings or another pelvic abnormality.

Other common indications include:

  • Absent or infrequent periods and selected menstrual-cycle concerns.
  • Possible polycystic ovarian morphology as one part of a wider hormonal assessment.
  • Infertility evaluation, including ovarian follicle and endometrial assessment when specifically requested.
  • Checking the position of an intrauterine contraceptive device when indicated.
  • Assessing the endometrium after postmenopausal bleeding or an abnormal examination.
  • Following a finding seen on CT, MRI, pregnancy imaging or a previous ultrasound.
  • Looking for a collection or complication after selected operations and procedures.
  • Planning image-guided treatment or further gynaecological investigation.

Pregnancy imaging uses a dedicated clinical pathway. If pregnancy is possible, tell the referring clinician and radiologist because a pregnancy test and an appropriately timed early-pregnancy scan may be needed.

What Does the Radiologist Examine?

Uterus Position, size, shape and muscle texture are assessed. Fibroids, features of adenomyosis, congenital shape differences and scars may be documented when visible.
Endometrium The lining of the uterus is measured and assessed in relation to age, cycle stage, bleeding, hormone use and menopause. Thickness alone is not a diagnosis.
Cervix Visible cervical structure, cysts, a mass or fluid may be noted. Ultrasound does not replace cervical screening, speculum examination or tissue sampling when those are required.
Ovaries Size, position, follicles, cysts, solid areas and blood flow are assessed where visible. Normal ovaries can be difficult to see after menopause or when obscured by bowel gas.
Adnexa The areas around each ovary and fallopian tube are checked for a mass, dilated tube or other abnormality. Normal fallopian tubes are usually not visible.
Pouch of Douglas and pelvic spaces Free fluid, blood or a collection may be visible. A small amount of physiological fluid can occur around ovulation and must be interpreted in context.
Urinary bladder The filled bladder acts as a window during the external scan. A dedicated urinary-tract scan is needed for detailed bladder wall, kidney or post-void assessment.
Blood flow when relevant Colour and spectral Doppler may help assess ovarian or lesion blood flow. Doppler findings are only one part of the assessment and do not independently exclude torsion or diagnose cancer.

What Can Pelvic Ultrasound Miss?

  • Superficial or small deposits of endometriosis and many pelvic adhesions.
  • Small endometrial polyps or subtle abnormalities within the uterine cavity.
  • Normal fallopian tubes and some tubal disease.
  • Very small ovarian or pelvic lesions, particularly with technically limited views.
  • The cause of pelvic pain when it arises from bowel, bladder, muscles, nerves or other structures.
  • Microscopic cancer or the exact tissue type of an indeterminate mass.
  • Complete assessment when the ovaries are obscured by bowel gas or lie high in the pelvis.

A normal pelvic scan does not mean symptoms are imagined and does not exclude every gynaecological condition. Depending on the clinical question, the next step may be examination, laboratory tests, MRI, hysteroscopy, saline sonography, laparoscopy or specialist review.

How Should I Prepare?

Follow the instructions issued for your appointment because the correct bladder preparation depends on which route is planned. You do not usually need to fast for a routine pelvic ultrasound.

For the external scan Attend with a comfortably full bladder. Drink the amount stated in your appointment instructions and avoid passing urine until the first part of the scan is complete.
For the internal scan You will normally empty your bladder immediately beforehand. Remove a tampon or menstrual cup before the examination.
Medicines and food Eat, drink and take regular medicines normally unless another test requires different preparation. Do not change hormone treatment without advice.
If your bladder becomes painful Tell reception. You may be advised to release a small amount rather than becoming distressed. Patients with bladder or fluid restrictions should contact the team in advance.
  • Wear loose, two-piece clothing that allows access to the lower abdomen.
  • Bring the referral, relevant blood results and previous ultrasound, CT, MRI or operation reports.
  • Know the first day of your last menstrual period if applicable and mention hormone or fertility treatment.
  • Tell the team if pregnancy is possible, even if the scan was requested for another reason.
  • Mention latex sensitivity, mobility needs, pelvic pain, previous trauma or concerns about an intimate examination.

What Happens During the External Scan?

1 Your history and bladder preparation are checked

The radiologist confirms the reason for scanning, symptoms, menstrual or menopausal status, relevant treatment and whether the bladder is adequately filled.

2 The lower abdomen is exposed

You lie on your back and lower clothing slightly while remaining covered. Water-based gel is placed between the navel and pubic region.

3 The probe moves over the pelvis

Gentle pressure helps obtain images through the bladder. A very full bladder or an already painful area can make this part temporarily uncomfortable.

4 Overview images are recorded

The uterus, endometrium, ovaries and wider pelvis are assessed where visible. Measurements and relevant findings are saved.

5 An internal scan may be offered

The radiologist explains whether closer views could answer the clinical question better. You can ask questions and decide whether to proceed.

6 You empty your bladder if proceeding

The external portion ends first. You are then given privacy to use the toilet before the transvaginal examination.

What Happens During a Transvaginal Scan?

At SR Speciality Hospital, intimate pelvic ultrasound is performed by female radiologist Dr. Priyanka Venu with strict attention to privacy, dignity and comfort.

1 The examination is explained and consent confirmed

You can discuss worries, decline the scan or request a chaperone. Students or additional staff are not present without permission, apart from support required by hospital policy.

2 You prepare in privacy

After emptying the bladder, you undress from the waist down behind a screen and are covered with a clean sheet or drape.

3 The probe is protected and lubricated

A slim ultrasound probe is cleaned, covered with a single-use protective sheath and lubricated with gel. Tell the team about latex sensitivity before the examination.

4 The probe is placed gently within the vagina

The probe remains in the vagina and does not enter the cervix or uterus. It is moved slowly through small angles to obtain views of the uterus and ovaries.

5 You remain in control throughout

Tell the radiologist immediately about pain, anxiety or discomfort. The position or pressure can be adjusted, the examination paused or stopped completely.

6 The probe is removed and you dress in privacy

Images are saved, the probe is withdrawn and you are offered tissues before being given time to dress. No routine aftercare is needed.

The internal portion commonly takes around 10–15 minutes, while a combined appointment may take about 20–30 minutes. It is usually painless but may feel uncomfortable, particularly if pelvic organs are tender.

What Do Common Report Terms Mean?

Anteverted / retroverted uterus The uterus tilts forwards or backwards. These are common anatomical positions and usually do not represent disease.
Bulky uterus The uterus measures larger than expected. Fibroids, adenomyosis and previous pregnancy are among possible explanations; the rest of the report provides context.
Fibroid / leiomyoma A common benign growth of uterine muscle. Location, size and relationship to the endometrial cavity influence symptoms and management more than its presence alone.
Adenomyosis Endometrial-type tissue is present within the uterine muscle. Ultrasound may show supportive features, but symptoms and sometimes MRI are needed for complete assessment.
Endometrial thickness A measurement of the uterine lining. Interpretation depends on age, cycle stage, menopause, bleeding pattern, pregnancy possibility and hormone use.
Follicle / corpus luteum Normal cycle-related ovarian structures. They may look cystic and can change or disappear on a later scan.
Simple or haemorrhagic ovarian cyst A simple cyst contains clear fluid; a haemorrhagic cyst contains blood from a functional cyst. Age, size, symptoms and appearance determine whether follow-up is needed.
Endometrioma An ovarian cyst with features associated with endometriosis. Ultrasound cannot exclude endometriosis elsewhere in the pelvis.
Polycystic ovarian morphology An ovary has a particular follicle pattern or volume. This is not the same as polycystic ovary syndrome, which requires clinical and/or hormonal features as well.
Adnexal lesion / indeterminate mass A finding is present near an ovary or fallopian tube but is not fully characterised. Follow-up, MRI, blood tests or specialist assessment may be recommended.

What is O-RADS?

O-RADS means Ovarian-Adnexal Reporting and Data System. It gives radiologists standard terms for describing ovarian and adnexal findings and helps communicate the level of imaging concern and an appropriate next step. It is not a cancer diagnosis or stage.

O-RADS 0 The assessment is incomplete, so repeat ultrasound or another examination may be needed.
O-RADS 1 The ovaries are normal or show expected physiological findings.
O-RADS 2 The finding is almost certainly benign; no action or imaging follow-up may be advised.
O-RADS 3 The concern for malignancy is low, but gynaecology review, specialist ultrasound, follow-up or MRI may be advised.
O-RADS 4 More evaluation is required, commonly including MRI and specialist clinical assessment.
O-RADS 5 The imaging appearance has higher concern and appropriate specialist referral is recommended.

The written recommendation matters more than the score alone. Menopausal status, symptoms, lesion size, earlier imaging, tumour markers and personal risk all influence the final plan.

What Happens After the Scan?

Many findings are normal, physiological or benign. Others need correlation or surveillance. The referring clinician combines the report with symptoms, examination and laboratory results.

  • No further imaging when the examination is normal or a finding is confidently benign.
  • Pregnancy testing, blood count, hormone tests or selected tumour markers for a defined clinical question.
  • Repeat ultrasound at a recommended interval or a particular menstrual-cycle stage.
  • Gynaecology review for abnormal bleeding, fibroids, suspected endometriosis or an adnexal finding.
  • Pelvic MRI for deeper mapping or characterisation of an indeterminate lesion.
  • Saline sonography or hysteroscopy when the uterine cavity requires closer assessment.
  • Endometrial sampling or another biopsy when tissue diagnosis is clinically indicated.
  • Urgent specialist assessment when symptoms or imaging raise immediate concern.

Ask who will discuss the result and arrange any follow-up. Do not assume that a recommended repeat scan, MRI or specialist appointment has been booked automatically.

Myth vs Fact

Myth An internal pelvic scan is compulsory.
Fact A transvaginal scan is optional and requires informed consent. You can decline or stop at any time, and the available alternatives will be explained.
Myth A period automatically means the scan must be cancelled.
Fact Pelvic and transvaginal ultrasound can usually be performed during menstruation. Tell the team if you are uncomfortable or if the scan was timed for a particular cycle day.
Myth A full bladder is needed for every part of the scan.
Fact A full bladder helps the external scan. The bladder is normally emptied before the internal scan so the probe can approach the pelvic organs closely.
Myth A normal ultrasound rules out all endometriosis.
Fact Ultrasound can detect endometriomas and some deep disease, but superficial endometriosis and adhesions may not be visible. Persistent symptoms still need clinical review.

Frequently Asked Questions

How full should my bladder be?

Follow the volume and timing on your appointment instructions. The aim is a comfortably full—not painfully overfilled—bladder. Tell reception if you are distressed or cannot safely drink the advised amount.

Is the transvaginal scan painful?

It is usually painless but may cause pressure or discomfort, especially when the pelvis is tender. Tell the radiologist immediately. The angle can be adjusted and the scan can be paused or stopped.

Does the probe enter the uterus?

No. The ultrasound probe remains within the vagina. It does not pass through the cervix and no speculum is normally used for a routine transvaginal ultrasound.

Can the scan be performed during my period?

Usually, yes. Menstrual bleeding does not prevent the examination. Remove a tampon or menstrual cup before an internal scan and tell the team if you would prefer to reschedule.

What if I have never been sexually active?

Tell the radiologist privately before the examination. A transabdominal scan is normally used, and an internal scan is not performed without confirming medical appropriateness and your fully informed consent. Marital status alone is not a medical test of suitability.

Will the internal scan affect my fertility?

No. A routine transvaginal ultrasound uses sound waves and does not enter the uterus or damage the ovaries. It does not reduce fertility.

Can I have a female radiologist?

Yes. At SR Speciality Hospital, pelvic and transvaginal ultrasound is performed by female radiologist Dr. Priyanka Venu, with careful attention to privacy and comfort.

Can I bring someone with me?

You may ask to have a support person present where space, privacy and hospital policy allow. A trained chaperone can be present for the intimate examination.

What if I might be pregnant?

Tell the radiologist before the scan. Ultrasound itself does not use ionising radiation, and both abdominal and transvaginal routes can be used in pregnancy when clinically appropriate. The referral, pregnancy test and urgency determine the correct protocol.

When will I receive the result?

The radiologist reviews the images and issues a formal report to the referring clinician. Timing varies with urgency and hospital workflow. Ask before leaving how and when the result will be discussed.

Related Patient Guides

Each examination uses a protocol designed for a particular organ and clinical question.

Radiology Antenatal Ultrasound Pregnancy and Obstetric Scans Read scan guide → Radiology USG Abdomen Abdominal / Whole Abdomen Ultrasound Read scan guide → Radiology Groin & Hernia Ultrasound Inguinal / Femoral Hernia Scan Read scan guide → Radiology Follicular Monitoring Ultrasound Follicular Tracking / Ovulation Study Read scan guide →

A Note From Our Doctors

The information on this page is intended to help you understand your condition. It should not be considered a diagnosis or a substitute for a consultation with a qualified medical professional.

Every patient is unique. The same symptom can have different causes in different individuals, and the most appropriate investigations and treatment depend on your medical history, examination findings, age, existing medical conditions and test results.

At SR Speciality Hospital, we believe in treating the whole patient—not just a symptom, scan or laboratory report. Every treatment plan is individualised after careful medical evaluation.

Radiology Appointments

Have you been advised to undergo pelvic ultrasound?

Contact the hospital with the exact referral so we can confirm bladder preparation and whether an internal scan may be offered. Female radiologist Dr. Priyanka Venu performs the examination in strict privacy and comfort.

Call the Hospital Contact Us