Sonovaginography: A Useful Technique in the Assessment of the Lower Genital Tract

Abstract

Conventional sonographic evaluation of the cervix and vagina is compromised by inattention, poor subject contrast, and obscuring artifacts. We describe a technique involving distention of the vaginal canal and fornices with ultrasound gel, providing an acoustic window for improved definition of the cervix and vagina. This exam is usually performed in concert with transvaginal sonography, but a transabdominal or transperineal approach may be more useful in selected scenarios. A wide variety of formerly sonographically inconspicuous conditions are demonstrable with this technique, many of which were undetected or inadequately characterized on the physical exam. Cervical polyps were the most commonly seen abnormality.

Undiagnosed Supra-vaginal Cervical Elongation in a Case of Recurrent Pelvic Organ Prolapse After Sacrospinous Hysteropexy: A Case Report

“…Johnson et al claimed that a Transvaginal sonogram gives a restricted evaluation of the cervix due to poor tissue discrimination from the vagina; in any case, sonovaginography is valuable at showing the portio vaginalis and outside cervical os and measuring cervical length (11).…”

The use of high-frequency ultrasonography in the assessment of selected female reproductive structures: the vulva, vagina and cervix

“…At present, vaginal imaging can be improved by applying other techniques of evaluation. Transabdominal ultrasound with the filled bladder (21,22) allows the presentation of advanced pathological lesions that arise from the cervical canal or vaginal portion of the cervix (23) . In transvaginal US, usually in the sagittal plane, where the end of the transducer touches the anterior edge of the cervix and the urinary bladder is visible just above the cervix, the internal opening is on the right side of the cervical canal (18,23) , and the evaluation of the unchanged vaginal walls is limited and uncertain.…”

“…Transperineal ultrasound offers more complete visualization of the lower part of the cervix and the vagina as well as lesions in this area that could be overlooked in a standard cervical and vaginal examination; in this scan, the transducer is fixed in the vaginal vestibule (17) . During sonovaginography, the evaluation of the vagina and cervix is conducted after filling the vagina with US gel and after assessment of these structure in 2D US (B-mode) and MRI (magnetic resonance imaging) (22,24) . Additionally, it is possible to visualize fistulae and defects of the vagina after gel application and assessment in 3D US (22,25) .…”

“…During sonovaginography, the evaluation of the vagina and cervix is conducted after filling the vagina with US gel and after assessment of these structure in 2D US (B-mode) and MRI (magnetic resonance imaging) (22,24) . Additionally, it is possible to visualize fistulae and defects of the vagina after gel application and assessment in 3D US (22,25) . The number of the presented methods shows how important imaging is for the evaluation of vaginal pathologies, which may be overlooked during a conventional examination.…”