Earlier this week, I had my first transvaginal ultrasound to (apologies if I inadvertently unlock a new fear here) locate the thread of my expired IUD, which has… been misplaced. Well, it hasn’t – it’s just not visible to the naked eye. And that means the sweet nurse who tried to remove it some weeks ago, despite the repositioning of my hips many, many times, couldn’t. And so began the search for the illusive string.

An initial call with my GP didn’t offer much guidance beyond confirming the appointment with my local gynaecologist, and the subsequent letter I received – random chunks of text harshly highlighted in neon yellow – explained little more than the fact that it was best not to have a full bladder while undergoing the scan.

Although the thought of the scan itself didn’t cause me much mental anguish (though, it very commonly can), I did have a lot of other, unanswered concerns. Did I need to do anything special – food and drink-wise – beforehand? What, exactly, would be picked up on the scan? And, were the treasure hunt successful, would I receive info on the whereabouts of the sneaky thread or even be able to have the IUD removed same-day?

I felt wholly unprepared which made an already fairly uncomfortable experience even more so. So, in a bid to help you get your head around what actually happens during an internal ultrasound, and give you a little peace of mind ahead of your appointment, here’s what you need to know.

“An ultrasound scan is an investigation to create an image on a screen of the organ or body part being examined using sound waves,” says Pradnya Pisal, consultant gynaecologist at London Gynaecology. “It is used to help in making a diagnosis so that appropriate treatment can be offered.” It is carried out by medical doctors and specially-trained healthcare professionals (sonographers), and is performed using an ultrasound probe that gives out high frequency ultrasound waves. “These sound waves cannot be heard,” Pisal says. “The size and shape of the ultrasound probe depends on the part of the body being examined.”

Initially, the process is similar to having a smear test. “You will be advised to empty your bladder and then undress completely from the waist down. A hospital gown or sheet will be given to cover you,” says Pisal. You’ll be asked to lie on your back on the ultrasound couch, feet planted with knees bent. “The knees will then be raised in a way that allows the scan to be performed easily.” Note: there will always be a chaperone when you have a transvaginal ultrasound.

A thin, elongated ultrasound probe is used for this procedure. “It is normally around 5-7 cms long and around the width of a finger,” says Dr Gareth Nye, senior lecturer of physiology at Chester Medical School. “Before insertion, the wand is covered with a sterile cover and lubricating gel. Some covers may contain latex, so any latex allergies must be communicated before this point.”

Pisal explains that the ultrasound probe will be moved into different positions, while in situ, in order to visualize the uterus and ovaries clearly. I didn’t experience any pain during this part, but she does note that while internal ultrasounds are generally painless you may experience some discomfort as the probe is inserted into your body. If you ever experience pain during penetration, flag this with your gynaecologist ahead of your appointment so they can advise best next steps.

“An ultrasound scan takes around 15-20 minutes, and it will be carried out in the ultrasound department or in the consulting rooms of the clinic,” Pisal says.

An internal ultrasound scan essentially takes clear pictures of the uterus and ovaries, and any abnormalities that may lie deep in the pelvis. “This specific ultrasound is usually used if you have symptoms of pelvic pain or abnormal bleeding,” says Nye. “It may additionally be used to check for fibroids, polyps, ovarian cysts or tumours, anatomical causes of infertility, or assessment of early pregnancy if an external abdominal ultrasound is not sufficient.” Or, in my case, naughty IUD threads.

“Essentially, it is used when the healthcare work requires a more detailed picture of the reproductive organs. In early pregnancy it is used to monitor baby growth if there is abnormal bleeding, and it can diagnose ectopic pregnancy or early miscarriage that may not be picked up in any other way.”

Depending on the nature of the scan, you may be informed of any findings immediately, or they may be sent straight to your GP to discuss in a later appointment. “If your scan is performed by a sonographer, if appropriate, they will tell you if any abnormality is detected,” Pisal reassures. “You will be given a report immediately or the report will be emailed to you. For pregnancy scans, you will be given a copy of the images of your baby.

“Your consultant will explain the scan findings, make a diagnosis and then discuss further investigations and treatment options.”

Although an internal ultrasound is the most efficient method of producing imagery of the uterus and nearby organs, it’s not the only option.

“The next option would be an external ultrasound, although this may not provide the detail, or potentially transrectal ultrasound,” says Nye. The former is the kind of ultrasound you probably associate with pregnancy, where a small handheld probe is moved over the part of the body being examined. The latter is precisely what it sounds like – a small ultrasound probe inserted into the rectum. “Depending on your symptoms and possible issue, you may be monitored with blood tests, you may be asked to go for an MRI scan or it may involve keyhole surgery to get the findings needed.”

Before having any kind of ultrasound scan, you’ll be advised (in my case, in letter form) of any instructions to help ensure the imagery comes out clear. I had to have an empty bladder for my internal ultrasound, but some scans require a full bladder. “This may be needed before a scan of your unborn baby, if you’re pregnant, or your pelvic area, for example,” Pisal advises. “You can eat as normal and you do not need to fast,” she adds. “There will be a toilet nearby to empty your bladder before or after the scan, as need be. If you are using a tampon, this will need to be removed before a vaginal scan,” but, the scan can go ahead if you happen to be on your period on the day of your appointment.

There aren’t any requirements where clothing is concerned, but I like to wear a long jumper on my top half, so that I don’t feel extra exposed, and bottoms that are quick and easy to get on and off. A jumpsuit, for instance, would be an absolute no-no for me.

In terms of mental prep, Nye recommends taking someone with you to help ease any anxiety you might have, and being really vocal with the healthcare providers at the appointment. “It is important to be as honest and include as much detail about the reasons you have been asked to come as possible, nothing should be considered embarrassing to discuss. If, for example, you are on your period, it’s better to let them know than not.” Do ask any and all questions, and make the sonographer aware of any trauma that might make the scan especially difficult – physically, mentally or emotionally – or uncomfortable.

“You can request a female sonographer, and you can also ask for a local anaesthetic gel to be used to make the scan less uncomfortable,” Pisal reassures. “If you think that you may not be able to go through a transvaginal scan, you can request a transabdominal scan or an MRI scan.”

Main image: Getty