Is a Transvaginal Ultrasound Painful or Just Uncomfortable?

You’ve been offered a transvaginal ultrasound. You’re googling questions in bed at 2am. You’re wondering if it will hurt, how big the probe is and what happens during the scan. Welcome to one of the most requested pelvic investigations in gynaecology, and also the most googled.

Don’t worry. We’ll let you in on what happens during the scan, how most women actually feel during it, when it can hurt and what you can do to make your experience as easy as possible.

What Is a Transvaginal Ultrasound and Why Is It Done?

During transvaginal ultrasound scan services (also referred to as TVS or internal pelvic scan), high-frequency sound waves are used to produce images of the pelvic organs. The primary organs visualized during this exam are your uterus, ovaries, cervix and fallopian tubes. The vaginal probe allows your sonographer to view your pelvic organs from the inside, rather than the outside of your abdomen. This allows for better images with higher resolution.

This type of scan is used for a wide range of reasons, including:

• Investigating pelvic pain or irregular bleeding

• Monitoring early pregnancy

• Checking the position of a coil (IUD)

• Assessing ovarian cysts or fibroids

• Investigating suspected endometriosis

• Checking the thickness of the uterine lining

• Evaluating fertility concerns

The internal approach isn't just a default preference; it produces sharper images than an abdominal scan for most pelvic conditions, which means your clinician gets better diagnostic information from it.

Is a Transvaginal Ultrasound Painful or Uncomfortable?

The short answer: It's not supposed to hurt, but most women find it uncomfortable.

Guy's and St Thomas' NHS Foundation Trust says: "Unless the cause of your symptoms is already causing you pain, you should not experience any pain during the scan. It's similar to having a cervical screening (smear) test. For most women, it's not as uncomfortable as that."

University Hospitals Sussex NHS Foundation Trust adds: "The procedure is well tolerated by most patients and discomfort can be minimized by relaxing your pelvic muscles."

There's a difference between pain and discomfort. Discomfort is an unfamiliar pressure or sensation - it's knowing there's something moving around inside you. Pain, medically speaking, is your body telling you that something is wrong in a sharp or acute way.

Most will feel pressure or fullness. Some may feel strange knowing there's a probe inside them but they won't feel pain. Women describe the feeling as having pressure in your pelvic region. The actual scan will take around 15-20 minutes and most people don't feel that's long enough for it to hurt.

What Does the Procedure Actually Feel Like? Step by Step

Understanding the mechanics of the scan can go a long way in reducing pre-procedure anxiety.

1. Before the scan begins, you'll be asked to empty your bladder (unlike an abdominal pelvic scan, which requires a full one). You'll undress from the waist down and be given a sheet for privacy. You'll lie on an examination table with your knees bent  similar to a smear test position.

2. The probe itself is slim, smooth, and shaped to fit comfortably within the vaginal canal. The sonographer covers it with a sterile protective sheath (similar to a condom) and applies lubricating gel to reduce friction. The probe is then inserted a few inches  roughly 2 to 3 inches  into the vagina.

3. During imaging, the sonographer gently rotates and tilts the probe to capture views from different angles. This is the stage where you might feel a mild pressure or awareness of movement. The Cleveland Clinic notes that the transducer is specifically shaped to fit the curve of the vagina, and the lubricating gel helps it glide in without resistance.

4. After the scan, you may notice a small amount of gel discharge, which clears up within 24 hours. Some women experience very mild cramping or light spotting, though both are uncommon.

You are in control throughout. If anything feels uncomfortable or you want a moment to pause, tell the sonographer. Cancer Research UK is clear on this: the scan can be stopped at any point on your request.

When Might a Transvaginal Ultrasound Feel More Uncomfortable?

Whilst the scan is well-tolerated overall, there are specific situations where it may feel more uncomfortable than usual  and it's worth knowing about them in advance.

• If you already have pelvic pain: If your pelvic organs are already inflamed or sensitive due to a condition like endometriosis or pelvic inflammatory disease, the pressure of the probe against those tissues can feel more noticeable. This is not the scan causing harm, it's the existing condition making the area tender.

• If you have endometriosis: Women with endometriosis may find a transvaginal ultrasound more uncomfortable than average. This is because the sonographer may need to assess organ mobility and apply gentle pressure to specific areas to check for adhesions, which can be tender in areas affected by the condition. Radiopaedia notes that in deep endometriosis assessments, frequent check-ins on patient comfort are considered essential.

• If you have fibroids or ovarian cysts: Large fibroids or cysts can alter the position of the pelvic organs, meaning the sonographer needs to manoeuvre the probe more to get a complete image. This can increase the sensation of pressure.

• If you have vaginismus or a history of trauma: Vaginismus is a condition where the vaginal muscles involuntarily tighten, which can make any internal examination uncomfortable. Women who have experienced sexual trauma may also find the procedure more distressing. If this applies to you, let the clinic know in advance so they can take extra care, go more slowly, or discuss whether an abdominal scan might serve the diagnostic need instead.

• If you are postmenopausal: Reduced oestrogen levels after menopause can lead to vaginal dryness and thinning of the vaginal walls (atrophic vaginitis), which may make the insertion of the probe feel more uncomfortable. Again, this is manageable  letting your sonographer know beforehand means they can use more lubricating gel and proceed more gently.

  
  

How to Make a Transvaginal Ultrasound More Comfortable

There are a few practical things you can do before and during the scan to reduce discomfort.

• Breathe slowly and stay as relaxed as possible: Tensing your pelvic muscles makes the insertion of the probe harder and more uncomfortable. Taking slow, deliberate breaths before and during the scan genuinely helps. VeryHealth and MedicineNet both note that slow, controlled breathing reduces the physical sensation of discomfort during the procedure.

• Tell the sonographer about any concerns beforehand: If you have a history of pelvic pain, vaginismus, or trauma, say so at the start of the appointment. A good sonographer will adjust their approach accordingly.

• Ask for a female sonographer if that matters to you: Many clinics  including NHS departments  can arrange this if you let them know when booking. Sheffield Teaching Hospitals NHS Trust confirms that female staff can be specifically requested for this type of examination.

• Know that you can stop at any time: This is your body and your choice. Consent is ongoing throughout the procedure  you are not obligated to continue if you feel distressed.

• Empty your bladder fully before you arrive: A full bladder can add pressure during the scan, which increases discomfort. Most transvaginal scans require an empty bladder, so using the toilet shortly before you go in is advisable.

  
  

Read More: Best Private Ultrasound Scanning Services in London

Transvaginal Ultrasound vs. Transabdominal Ultrasound: Which Is Better?

So you may be asking, can’t I just get the outside version? Well, here’s the truth: You can request it and most doctors will agree to it. You’ll need a full bladder for a transabdominal ultrasound, as the wand is held externally on your lower abdomen.

The downside? Image clarity. No matter how much your bladder distends, you will never get images as clear as those from a transvaginal ultrasound when it comes to the uterus and ovaries, especially early on in pregnancy and for identifying smaller structures like endometriomas and thin-walled ovarian cysts. The probe is simply closer to your organs from the inside.

In fact, Whittington Health NHS Trust points out that most patients find transvaginal scanning less uncomfortable than enduring the pressure of a full bladder during a transabdominal scan. So you know. 

If you just can’t handle the thought of someone shoving a probe up inside you, however, talk to your doctor. If you’re not super concerned with obtaining the crystal-clear image you’d get with a transvaginal ultrasound, your doctor may be able to get sufficient information from a transabdominal ultrasound.

Why Getting an Accurate Scan Matters

I promise you that a transvaginal ultrasound isn’t pleasant but it is over quickly. What that scan can provide for you in answers is invaluable. If done well it can highlight ovarian cysts, fibroids in your uterus, signs of endometriosis, early pregnancy (including ectopic), or abnormalities with your uterine lining that you may not have known were there until they became worse.

myGynaePlus is a women’s health clinic located in West London that prides itself on performing ultrasound scans with comfort in mind. Their scans are performed by senior consultants using state of the art machines. Their ultrasound services include early pregnancy scans, fertility scans and gynaecological scans.

Every gynaecological in London investigation should be performed with the intent of getting you and your clinician more information so that you can make educated decisions about your health. An uncomfortable ten to fifteen minutes could save you months or years of wondering when you have the answers in front of you.

What Happens After a Transvaginal Ultrasound?

You can return to your usual activities straight after your scan. You don’t need to take any time off work and there are no driving, eating or drinking restrictions. Some women have a little spotting or mild cramping after their scan. If you have heavier bleeding than usual, severe pain or symptoms of infection, get in touch with your healthcare provider.

Timing of when you’ll get results varies from place to place. Some clinics, like those for postmenopausal bleeding, will discuss results with you the same day. Elsewhere, your referring doctor will receive a written report within a few days and discuss this at a follow-up appointment.

At myGynaePlus you can expect scans with clear communication. You’ll leave after your scan knowing what your cervix and womb looked like, instead of wondering for days.

Frequently Asked Questions

1. Will a transvaginal ultrasound hurt if I've never had penetrative sex?

The probe is slim and designed for comfort, but if you have concerns about this, it's worth mentioning to the sonographer before the scan begins. They can use extra lubricant, proceed very slowly, or in some cases arrange an alternative approach depending on the clinical situation. Your comfort and consent matter throughout.

2. Can I have a transvaginal ultrasound during my period?

Yes. Menstruation does not prevent the scan from taking place or affect the quality of the images. However, you will need to remove a tampon before the scan begins. A menstrual cup would also need to be removed.

3. How long does a transvaginal ultrasound take?

Most transvaginal ultrasounds take between 15 and 20 minutes. If a more detailed assessment is needed  for example, in a suspected deep endometriosis investigation  the scan may take up to 30 to 45 minutes.

4. Is it normal to feel emotional after a transvaginal ultrasound?

Yes, and it's more common than people realise. The procedure is intimate, and for some women  especially those with a history of trauma, anxiety about their health, or previous difficult experiences  it can bring up strong feelings. Give yourself time afterwards, and speak to your GP or a counsellor if the feelings persist.

5. Does a transvaginal ultrasound use radiation?

No. Ultrasound uses high-frequency sound waves, not radiation. This makes it safe to use during pregnancy and appropriate for repeated scans when monitoring a condition over time. There are no known risks to mother or foetus from diagnostic ultrasound used by trained professionals.