Annals of African Medicine
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Table of Contents
Year : 2015  |  Volume : 14  |  Issue : 1  |  Page : 52-56  

Transvaginal sonography is feasible and universally acceptable to women in Ibadan, Nigeria: Experience from the 1 st year of a novel service

1 Department of Obstetrics and Gynaecology, College of Medicine, University of Ibadan, Ibadan, Nigeria
2 Adeola Odeku Ultrasound Centre, Kongi, New Bodija, Ibadan, Nigeria

Date of Web Publication7-Jan-2015

Correspondence Address:
Folasade A Bello
Department of Obstetrics and Gynaecology, University College Hospital, PMB 5116, Ibadan
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1596-3519.148740

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Background: Transvaginal sonography (TVS) is the standard route for gynecological and early pregnancy assessment scanning, due to the higher resolution that allowed for a better view of the pelvis. It had not been available in the study area prior to this, and it was anticipated that clients would find it intrusive and unacceptable, and thus decline it. The study was aimed at accessing the acceptability of TVS in women.
Method: A cross-sectional study of all clients who presented for gynecological and early pregnancy assessment scans at a private ultrasound diagnostic center in Nigeria during its 1st year of service. All suitable clients were counseled for TVS. This was carried out for them, while nonconsenters had transabdominal sonography. A questionnaire was administered to the consenting participants. Virgins and women currently experiencing heavy vaginal bleeding were excluded. Data were entered into SPSS-16 and analyzed with frequency tables.
Results: Five hundred and seventy-seven women of varied demographic characteristics were included into the study. Only one (i.e., 1/577; 0.2%) declined TVS. The procedure was abandoned in one (i.e., 1/576; 0.2%) due to severe discomfort. All 575 that completed the examination stated they would accept TVS again in the future, if indicated.
Conclusions: TVS was universally accepted by a diverse population of women in South-Western Nigeria. It is recommended that ultrasound scan providers in this location should acquire skills for it, if necessary, and that TVS be offered routinely for gynecological evaluation according to international standards.

   Abstract in French 

L'échographie transvaginale (TVS) est l'itinéraire standard pour évaluation gynécologique et début de grossesse, numérisation, en raison de la plus haute résolution qui permettent une meilleure vue du bassin. Il n'avait pas été disponible dans la zone d'étude avant cela, et il était prévu que les clients seraient jugent intrusive et inacceptable et donc refuser. L'étude visait à accéder à l'acceptabilité des téléviseurs chez les femmes.
Méthode: Une étude transversale de tous les clients qui ont présenté pour évaluation gynécologique et début de grossesse scanne dans un centre de diagnostique échographie privée au Nigeria au cours de la 1re année de service. Tous les clients appropriés ont été conseillés pour les téléviseurs. Cela a été effectué pour eux, tandis que nonconsenters avait l'échographie transabdominale. Un questionnaire a été administré aux participants consentants. Vierges et femmes actuellement en proie à des saignements vaginaux abondants ont été exclues. Données saisies dans SPSS-16 et analysées avec les tableaux des fréquences.
Résultats: Cinq cent soixante-dix-sept femmes de diverses caractéristiques démographiques ont été incluses dans l'étude. Seule (c'est-à-dire, 1/577; 0,2 %) a diminué de TVS. La procédure a été abandonnée dans l'un (c.-à-d., 1/576; 0,2 %) en raison de l'inconfort sévère. 575 tous que l'examen a indiqué ils accepteraient de TVS à nouveau à l'avenir, si indiqué.
Conclusions: TVS a été universellement acceptée par une population diverse de femmes en South-Ouest du Nigeria. Il est recommandé que les fournisseurs de scan d'échographie à cet endroit devraient acquièrent des compétences, si nécessaire, et que TV diffusée régulièrement pour évaluation gynécologique conformément aux normes internationales.
Mots-clés: UNcceptability, Ibadan, Nigeria, transvaginale scan,échographie transvaginale

Keywords: Acceptability, Ibadan, Nigeria, transvaginal scan, transvaginal sonography

How to cite this article:
Bello FA, Odeku AO. Transvaginal sonography is feasible and universally acceptable to women in Ibadan, Nigeria: Experience from the 1 st year of a novel service. Ann Afr Med 2015;14:52-6

How to cite this URL:
Bello FA, Odeku AO. Transvaginal sonography is feasible and universally acceptable to women in Ibadan, Nigeria: Experience from the 1 st year of a novel service. Ann Afr Med [serial online] 2015 [cited 2023 Mar 30];14:52-6. Available from:

   Introduction Top

Since the introduction of medical ultrasonography, it has evolved into a basic, necessary part of gynecologic and obstetric evaluation. It employs sound waves, rather than harmful radiation like X-rays do, and so far, in utero exposure has not been found to be unsafe. Long term follow-up of children exposed to ultrasound scans before birth did not indicate that scans have a detrimental effect on children's physical or intellectual development. [1] The transvaginal route began to gain popularity with the introduction of high-frequency probes specifically designed for intravaginal use. [2],[3] The higher resolution obtained was found to be more useful in gynecology, whose field is mostly limited to the pelvis. The vaginal probe's proximity to the pelvis affords a detailed view.

In the study area, transabdominal sonography (TAS) has traditionally been employed for pelvic and early pregnancy assessment, despite the evidence in favor of transvaginal sonography (TVS). The latter is recommended on account of the better image resolution of the endocavity vaginal probe, resulting in improved pelvic evaluation. Hindrances to TAS like bowel gas, obesity and a retroverted uterus do not preclude accuracy with TVS. [4] It allows for accurate serial assessment of follicular and endometrial dynamics during the evaluation of infertility; or endometrial evaluation in abnormal uterine bleeding, including postmenopausal endometrium. [5],[6],[7] It also obviates waiting time for bladder filling and the discomfort of holding a full bladder for the examination. [8] It has been shown to be useful in first trimester fetal anatomy scans (12-14 weeks) to help diagnose anomalies earlier than the routine mid-trimester scan. [8],[9] Its demerits are that it only has a small field of view and may not be able to visualize the full extent of large masses. TAS is of better value in obtaining a global view of the pelvis and evaluating larger pelvic masses. [10] In those situations, TAS is needed in a complimentary role. TVS is of more value in assessing early pregnancy, ectopic pregnancy, and for visualizing the ovaries. It is also useful for determining mid-trimester cervical length to predict preterm delivery. [11] It is often anticipated that this route would not be culturally acceptable in many populations on account of its invasiveness; in the study area, anecdotal observations indicated that even medical personnel had this perception.

A study carried out in the earlier days of TVS for early pregnancy assessment in the UK had 88% of women consenting to the procedure. [8] The main reasons for declining were fear of miscarriage and discomfort. Other studies have corroborated this high level of acceptance, [12],[13],[14] irrespective of the gender of the sonographer or the state of the pregnancy. [15] TVS was found to be acceptable in a cohort of postmenopausal women being screened for ovarian cancer, with only a few reporting discomfort or pain; despite expected genital atrophy from their low-estrogen state. [16] A survey of women in Nigeria who had been referred for TAS showed that 84% of women would be willing to have TVS. [17]

At the commencement of services at the facility where this study was carried out, referrals were sought from clinicians in the study area. Many clinicians were unfamiliar with the TV route at the time, and expressed skepticism about the willingness of clients to consent to the procedure due to its perceived invasiveness and the connotations for cultural acceptance. The aim of the study was, therefore, to access the acceptability of the transvaginal route in women who needed ultrasound scanning evaluation and their experience of the examination. The study reports the first year of service at an ultrasound facility.

   Methods Top

All procedures followed were in accordance with the Helsinki Declaration. Consent to participate in the study was obtained from all recruited patients.

The study was a cross-sectional descriptive study. It was carried out at a privately-owned ultrasound diagnostic facility in Nigeria, which offers services to only female clients requiring reproductive health scans. The study area was Ibadan, a large town in South-Western Nigeria that consists of urban, semi-urban and rural communities. As TVS was unavailable in the area prior to this facility's opening, most referrals did not indicate the route of examination required. As previously stated, all medical providers that were approached for referrals were informed of the availability of TVS. Many of these providers were doubtful of its acceptance among clients.

A total sample of all patients who presented for gynecological or early pregnancy assessment over 1 year was employed. Verbal consent for the TV examination was sought after they were informed about the procedure, its benefits and demerits, and that they could have a more familiar transabdominal scan, if they preferred. They could also indicate that they wanted the procedure terminated in preference for TAS at any time, if they felt discomfort or embarrassment. Written consent for the survey was obtained, which consisted of a short interviewer-administered questionnaire to obtain their demographic information and acceptance of TVS. Many scan requests simply stated "pelvic ultrasound scan" or "uterine and ovarian assessment," without giving further clinical information. In those situations, questions were asked to determine the indication. In those cases where clinical indication could not be determined, or the scans were requested as part of routine examinations, they were classified as "routine." Attitude toward accepting another TVS in the future was subsequently assessed after the procedure. The same sonographer, who was a female, performed all scans. Exclusion criteria included women who had not had sexual intercourse at least once and those with heavy vaginal bleeding.

Consenting patients had TVS in the dorsal position; 5.0 MHz and 6.0 MHz transvaginal probes (Hitachi Aloka Medical Ltd., Tokyo, Japan and Chison Medical Imaging Co. Ltd., Wuxi City, China, respectively) were employed. The probe was lubricated with gel and covered with a latex condom, which was again lubricated with gel before insertion.

Data obtained were entered into SPSS-16 (SPSS Inc, Chicago, USA). Explanatory variables were to include the participants' demographic characteristics, while outcome variables were to be their acceptance of, tolerance for, and perceived future acceptance of the procedure.

   Results Top

Six hundred and four women were referred for gynecological or early pregnancy ultrasound examinations over the study period. Five hundred and seventy-seven women met the inclusion criteria and were offered TVS. Of these, only one (0.2%) declined to have TVS. Of the 576 women that had TVS, the procedure was abandoned in one woman (0.2%) on account of extreme discomfort. The participants' ages ranged between 18 and 72 years; the mean age was 30.1 ± 5.9 years. [Table 1] shows their demographic characteristics. All levels of educational status were represented in the data set. All the participants had religious affiliations.
Table 1: The demographic characteristics of the study participants

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The indications for referral for ultrasonographic exam are shown in [Table 2]. Statistical analysis of the explanatory and outcome variables was not feasible, as the acceptance was nearly 100% (all but one participant declined). All the 575 (99.7%) women who completed the procedure affirmed that they would be willing to have the procedure again, if indicated.
Table 2: The indications for which transvaginal ultrasound scans were performed

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   Discussion Top

Transvaginal route of ultrasound scanning was overwhelmingly acceptable in this population of women, despite the fact that most of them were learning about the option for the first time, and were more familiar with TAS. Women of different ages, religions, parities, and educational and marital statuses were represented. These demographic characteristics did not influence acceptance. Due to the universal nature of acceptance, predictors of acceptance could not be identified. Women who had TAS in another facility in South-Western Nigeria mostly indicated that they would be willing to accept TVS. [17] However, none of the women in that survey had been subjected to the procedure before; neither was TVS done as part of the study. It may be difficult to determine if the participants would actually have gone through with it, as they indicated, or they even may have abandoned the procedure. The current study went further to offer, then performed TVS; and all but one patient completed the procedure. All the participants that completed it reiterated that they would be willing to have the procedure again in future, further reinforcing their favorable attitude to it.

Counseling goes a long way to help patients make informed decisions, especially when bringing new services to them. It had been anticipated that a significant number of study participants would prefer to have a more familiar TAS, and then return to their regular health care provider to get a recommendation on TVS for future use. All women who presented for early pregnancy assessment agreed to have TVS, and were not deterred by the potential fear of miscarriage as expressed in a previous study. [8] Many of the clients involved in this study have subsequently had repeat TVS at this center, sometimes specifically requested by their doctors thereafter. Avoidance of the inconvenience of bladder-filling and the discomfort of having a probe applied firmly over their full bladders for the exam are advantages over TAS that many of them claim have helped acceptance of TVS.

A potential limitation of the interpretation of this finding might be the female gender of the sonographer, as previously stated. However, previous studies have indicated that gender does not influence women's acceptance. [15],[17]

   Conclusion Top

TVS was universally accepted by a diverse population of women in South-Western Nigeria. It is recommended that ultrasound scan providers in this location should acquire skills for it, if necessary, and that this procedure be offered routinely for gynecological evaluation, as it is done internationally.

   Acknowledgments Top

The authors gratefully acknowledge Ms. Patience Ahmed and Ms. Omolara Akinbode of the Adeola Odeku Ultrasound Diagnostic Centre for their invaluable assistance in data collation.

   References Top

Whitworth M, Bricker L, Neilson JP, Dowswell T. Ultrasound for fetal assessment in early pregnancy. Cochrane Database Syst Rev 2010;4:CD007058.  Back to cited text no. 1
Timor-Tritsch IE, Bar-Yam Y, Elgali S, Rottem S. The technique of transvaginal sonography with the use of a 6.5 MHz probe. Am J Obstet Gynecol 1988;158:1019-24.  Back to cited text no. 2
Schwimer SR, Lebovic J. Transvaginal pelvic ultrasonography. J Ultrasound Med 1984;3:381-3.  Back to cited text no. 3
Freimanis MG, Jones AF. Transvaginal ultrasonography. Radiol Clin North Am 1992;30:955-76.  Back to cited text no. 4
Goldstein SR. Modern evaluation of the endometrium. Obstet Gynecol 2010;116:168-76.  Back to cited text no. 5
Batzer FR. Abnormal uterine bleeding: Imaging techniques for evaluation of the uterine cavity and endometrium before minimally invasive surgery - The case for transvaginal ultrasonography. J Minim Invasive Gynecol 2007;14:9-11.  Back to cited text no. 6
Nasri MN, Shepherd JH, Setchell ME, Lowe DG, Chard T. Sonographic depiction of postmenopausal endometrium with transabdominal and transvaginal scanning. Ultrasound Obstet Gynecol 1991;1:279-83.  Back to cited text no. 7
Braithwaite JM, Economides DL. Acceptability by patients of transvaginal sonography in the elective assessment of the first-trimester fetus. Ultrasound Obstet Gynecol 1997;9:91-3.  Back to cited text no. 8
Ebrashy A, El Kateb A, Momtaz M, El Sheikhah A, Aboulghar MM, Ibrahim M, et al. 13-14-week fetal anatomy scan: A 5-year prospective study. Ultrasound Obstet Gynecol 2010;35:292-6.  Back to cited text no. 9
Guy RL, King E, Ayers AB. The role of transvaginal ultrasound in the assessment of the female pelvis. Clin Radiol 1988;39:669-72.  Back to cited text no. 10
Heath VC, Southall TR, Souka AP, Novakov A, Nicolaides KH. Cervical length at 23 weeks of gestation: Relation to demographic characteristics and previous obstetric history. Ultrasound Obstet Gynecol 1998;12:304-11.  Back to cited text no. 11
Rosati P, Guariglia L. Acceptability of early transvaginal or abdominal sonography in the first half of pregnancy. Arch Gynecol Obstet 2000;264:80-3.  Back to cited text no. 12
Basama FM, Crosfill F, Price A. Women′s perception of transvaginal sonography in the first trimester; in an early pregnancy assessment unit. Arch Gynecol Obstet 2004;269:117-20.  Back to cited text no. 13
Dutta RL, Economides DL. Patient acceptance of transvaginal sonography in the early pregnancy unit setting. Ultrasound Obstet Gynecol 2003;22:503-7.  Back to cited text no. 14
Salih Basama FM, Crosfill F, Price A. The gender of the examiner, the state of the pregnancy and women′s perception of transvaginal sonography in the first trimester. Eur J Ultrasound 2003;16:237-41.  Back to cited text no. 15
Gentry-Maharaj A, Sharma A, Burnell M, Ryan A, Amso NN, Seif MW, et al. Acceptance of transvaginal sonography by postmenopausal women participating in the United Kingdom Collaborative Trial of Ovarian Cancer Screening. Ultrasound Obstet Gynecol 2013;41:73-9.  Back to cited text no. 16
Atalabi OM, Morhason-Bello IO, Adekanmi AJ, Marinho AO, Adedokun BO, Kalejaiye AO, et al. Transvaginal ultrasonography: A survey of the acceptability and its predictors among a native African women population. Int J Womens Health 2012;4:1-6.  Back to cited text no. 17


  [Table 1], [Table 2]

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