What is a Pelvic Ultrasound, and Why Would I Need One? 

An ultrasound, also referred to as a sonogram, is a medical scan that uses high frequency sound waves to create images of the inside of the body. It is painless and safe. Ultrasound scans are routinely used to scan the lower abdomen to help doctors diagnose health problems affecting one or more of the organs in the pelvic cavity, including the reproductive organs, bladder and rectum. 

A pelvic ultrasound can diagnose a wide range of health conditions, and there are a number of different ways that ultrasounds of the pelvis can be carried out. 

What is a Pelvic Ultrasound?

The pelvis, or pelvic cavity, is the area between the tummy and the upper thighs and contains the pelvic organs including the bladder and the rectum. In female bodies, it also contains the womb (uterus), fallopian tubes, ovaries, cervix and vagina and in male bodies the pelvis contains the prostate gland and the seminal vesicles (the glands that mix fluid with sperm to produce semen). A pelvic ultrasound on a male may also include a scan of the testicles. 

A pelvic ultrasound is a medical scan used by doctors to look inside the pelvis. Such ultrasound scans can be non-invasive and external, where the apparatus is used outside of the body on top of the skin of the lower abdomen, or minimally-invasive and internal, where an ultrasound probe is used inside the vagina or the rectum. 

Why You Might Need a Pelvic Ultrasound

There are numerous reasons why a doctor or GP may suggest a pelvic ultrasound scan. They can help doctors understand the causes of pain or discomfort in the pelvic area or lower abdomen and why someone may be having difficulty conceiving.  They can help to find the cause of abnormal bleeding from the vagina or rectum and post menopausal bleeding. 

A pelvic ultrasound is also used to monitor pregnancy and to check on the health of a growing baby.

What a Pelvic Ultrasound Can Diagnose

A pelvic scan can help doctors diagnose a wide range of conditions, or help to rule them out. Once a doctor has made a diagnosis using ultrasound (sometimes alongside other scans and tests), a treatment plan can be put in place. The most common conditions that can be diagnosed with a pelvic ultrasound are: 

Uterine Fibroids

Uterine fibroids, sometimes known simply as fibroids, are a common type of benign (non-cancerous) fleshy growth that can develop in the lining of the womb (uterus). Smaller fibroids tend not to cause much pain, but larger ones can cause severe pain, very heavy periods, pain during sex, back pain and frequent urination. 

Ovarian Cysts

Ovarian cysts can develop on the inside or the outside of the ovaries. Some are harmless and cause no symptoms and they may clear up on their own. Others may cause pain, bleeding and potentially, infertility. 

Endometriosis

Endometriosis is a painful condition caused by the tissue from the lining of the womb (the endometrium) that would normally shed and leave the body during a menstrual period, migrating to other areas of the pelvic cavity and beyond. During a period, this tissue also bleeds, but the blood cannot leave the body through the vagina. This causes pain, sometimes severe, internal scar tissue and potentially infertility. 

Pelvic Inflammatory Disease (PID) 

PID is an infection that develops in the uterus, ovaries and/or the fallopian tubes. It can be the result of an untreated sexually transmitted infection (STI) such as chlamydia and causes abnormal vaginal discharge, pain in the lower abdomen and if left untreated, potentially infertility. 

Ectopic Pregnancy

An ectopic pregnancy is a pregnancy where the fertilised egg settles in the fallopian tube, rather than the lining of the uterus. It can be a dangerous and painful medical emergency that can result in the loss of the fallopian tube and requires urgent treatment. 

Ovarian Torsion

Large ovarian cysts can cause one or both of the ovaries to twist (torsion means to twist), causing the blood flow to the affected ovary to become cut off. This can lead to the death of the ovary, severe pain, vaginal discharge, nausea, vomiting and a fever. 

Uterine Abnormalities

Uterine abnormalities include fibroids, polyps and endometriosis, and can cause abdominal pain, pain during sex, discharge and abnormal vaginal bleeding.

Bladder Disorders

The bladder can be affected by relatively common conditions such as kidney stones, or more serious ones including bladder cancer. Symptoms of a bladder disorder include pain on urination, more frequent urination or a sudden and urgent need to urinate.

Prostate Conditions

The prostate can also be affected by conditions that may cause pain or changes to the frequency of urination. These can be benign conditions, such as an enlarged prostate, or cancerous. 

Pelvic Masses

Abnormal growths in the pelvic cavity can lead to pain, bleeding and problems with urination.

Early Pregnancy Complications

Some pregnancies can develop complications in the first few weeks and months, resulting in pain or blood loss from the vagina that could be a sign of miscarriage, ectopic pregnancy or a pregnancy that’s not developing normally. 

Fluid in the Pelvis

A ruptured (burst) cyst, infection, an ectoptic pregnancy, endometriosis or cancer can lead to a build up of fluid in the pelvic cavity, leading to pain and swelling in the lower abdomen. 

Uterine Polyps

Uterine, or womb, polyps, are usually benign (non-cancerous) growths that can develop in the lining of the uterus, causing pain and bleeding. They’re a common cause of post-menopausal vaginal blood loss. 

Cancer

Cancerous tumours in the ovary, womb or prostate can show as an abnormal mass on an ultrasound scan. This will normally prompt doctors to carry out more tests, including a biopsy (where a long, thin needle is used to remove cells from the mass for testing, often guided by an ultrasound machine to ensure accuracy), to diagnose cancer, or rule it out. 

Infertility Causes

Sometimes, cysts, infections and other abnormalities can cause infertility in both males and females. A pelvic ultrasound is often one of the first tests used to determine the cause of infertility. 

Types of Pelvic Ultrasounds

There are various different types of pelvic ultrasound and which one a doctor carries out will depend on the symptoms and gender of the patient. Some are external, where doctors use ultrasound equipment on the outside of the pelvic region, and some are internal, where an ultrasound probe is used inside the vagina or the rectum. 

Transabdominal Ultrasound

A transabdominal ultrasound is an external ultrasound, where the scanning equipment is placed onto the skin of the abdomen and moved around the area. It’s used to diagnose conditions affecting the organs of the pelvis, and may be used in conjunction with an internal ultrasound. A transabdominal ultrasound is also used to monitor the progress of a pregnancy. 

Transvaginal Ultrasound

A transvaginal ultrasound is a type of internal ultrasound where the probe used to perform the scan is inserted into the vagina. It’s used to diagnose conditions affecting the female internal reproductive organs including the uterus, fallopian tubes and ovaries. 

Transrectal Ultrasound

A transrectal ultrasound is a type of internal ultrasound where the probe used to perform the scan is inserted into the anus, up to the rectum. It’s used to diagnose conditions affecting the prostate. 

3D Pelvic Ultrasound

A 3D pelvic scan involves both an external ultrasound and an internal transvaginal ultrasound. It provides a more detailed image of the organs of the pelvis than a regular pelvic scan. 

Doppler Pelvic Ultrasound

A doppler pelvic ultrasound is essentially the same as an external transabdominal ultrasound, but uses special equipment to assess the blood vessels and the rate of blood flow to and from the pelvic area. 

Sonohysterography

A sonohysterography is an ultrasound scan used to look specifically at the endometrium and uterus for conditions such as fibroids, polyps or cancer. A saline solution is injected into the uterus through the vagina prior to scanning. 

Endoanal Ultrasound

An endoanal ultrasound is a type of internal transrectal ultrasound that looks at the strength of the muscles of the rectum, for example after childbirth or to diagnose defects in the muscular sphincters of the anal canal. 

How an Ultrasound of the Pelvis Works

During a pelvic exam using ultrasound, a special water based conductor gel is placed onto the skin of the lower abdomen. An ultrasound probe called a transducer is then placed onto the skin and used to send high frequency sound waves into the body, through the gel. 

The sound waves bounce back to the probe like an echo when they reach organs, tissues and fluids, and are then collated by computer programming to produce an image on a screen. While the probe is moved around the area, different images are collected that can then be captured and saved or printed off. These images are then reviewed by a radiologist who can detect changes and abnormalities in the organs. 

The transducer used in transrectal and transvaginal scans is shaped like a wand and works in the same way. It’s covered in gel before being carefully inserted 2-3cm into the anus or the vagina. 

Where It Takes Place

Ultrasound scans are usually performed in the radiology department of a hospital or clinic. 

Equipment Used

During an ultrasound, medical professionals use a computerised machine connected to an ultrasound probe called a transducer. A special conductor gel is placed onto the skin or the probe to conduct the sound waves produced by the transducer.

Who Performs a Pelvic Ultrasound?

A pelvic ultrasound is carried out by a medical professional called a sonographer. Sometimes, another medic called a radiologist will also be present. 

Benefits

External ultrasound scans are non-invasive and internal ultrasound scans are minimally invasive. This means that the procedure is usually quick and pain-free, and patients are able to return home the same day. Unlike having an X ray or a CT scan, there’s no radiation exposure. 

Risks & Side Effects

There’s no known side effects to having a pelvic ultrasound scan, as this type of medical imaging doesn’t use radiation. It’s therefore safe during pregnancy. 

An internal transvaginal or transrectal ultrasound may cause some mild discomfort or pressure. To avoid the risk of infection from the probe used in an internal ultrasound, the probe is covered with a condom beforehand, which is then disposed of afterwards. 

How to Prepare for a Pelvic Ultrasound

The preparation for a pelvic ultrasound will depend on the type of ultrasound scan being performed. For a transabdominal ultrasound scan, patients are asked to drink a litre of water beforehand, in order to have a full bladder. This helps to create clearer images of the pelvic cavity. Transrectal and transvaginal scans usually require you to empty your bladder immediately beforehand. 

Patients are usually asked to remove clothing and jewelry that might get in the way of the area being scanned, and will be provided with a medical gown. Most pelvic ultrasounds are completed within 30 minutes. 

The Procedures Explained: What to Expect

Transabdominal Ultrasound

Preparation: Drink a liter of water immediately prior to your scan. 

Procedure: Your sonographer will place a cool gel on your lower abdomen and will then slowly glide the transducer backwards and forwards over the area, stopping and pressing in certain places in order to capture images. 

Position: You will be required to lie on your back with your legs out straight. 

Transvaginal Ultrasound

Preparation: Empty your bladder immediately prior to your scan.  

Procedure: Your sonographer will place a condom onto the wand-shaped transducer, cover it with gel and gently insert it 2-3 cm into your vagina. They may move the transducer slightly from side to side in order to capture the right images. 

Position: You will be required to lie on your back with your knees bent, your legs slightly open and your feet in footrests or in stirrups. 

Transrectal Ultrasound

Preparation: Empty your bladder immediately prior to your scan. You don’t necessarily need to empty your bowel. 

Procedure: Your sonographer will place a condom onto the wand-shaped transducer, cover it with gel and gently insert it 2-3 cm into your anus. They may move the transducer slightly from side to side in order to capture the right images. 

Position: You will be required to lie on your side, facing away from your sonographer, with your knees bent up towards your chest. 

3D Pelvic Ultrasound

Preparation: Drink a liter of water immediately prior to your scan. 

Procedure: Your sonographer will perform the same procedure as for a transabdominal ultrasound, before asking you to empty your bladder. They will then perform the same procedure as for a transvaginal scan. 

Position: For the first scan, you will be required to lie on your back with straight legs, and for the second scan, you will be required to lie on your back with your knees bent, your legs slightly open and your feet in footrests or in stirrups. 

Doppler Pelvic Ultrasound

Preparation: Drink a liter of water immediately prior to your scan. 

Procedure: Your sonographer will conduct a regular transabdominal ultrasound, but you will hear a whooshing sound as they pick up the sounds of your blood flow. 

Position: You will be required to lie on your back with your legs out straight. 

Sonohysterography

Preparation: Empty your bladder immediately prior to your scan.

Procedure: Your sonographer will perform a regular transvaginal scan. They will then insert a catheter into the uterus through the cervix using a speculum. Once the catheter is in place, they will remove the speculum and insert the transducer into the vagina again. They will then transfer a sterile saline solution into the uterus through the catheter while capturing images via the transducer. 

Position: You will be required to lie on your back with your knees bent, your legs slightly open and your feet in footrests or in stirrups. 

Endoanal Ultrasound

Preparation: Empty your bladder immediately prior to your scan. You don’t necessarily need to empty your bowel. 

Procedure: Your sonographer will place a condom onto the wand-shaped transducer, cover it with gel and gently insert it 2-3 cm into your anus. They may move the transducer slightly from side to side in order to capture the right images. 

Position: You will be required to lie on your side, facing away from your sonographer, with your knees bent up towards your chest. 

What Happens After a Pelvic Ultrasound?

Once the sonographer is happy they have the right images, they will stop scanning and remove any gel left on the abdomen. They will provide tissue for patients having a transrectal or transvaginal scan to remove any leftover gel before getting dressed. Patients can return home the same day as a pelvic ultrasound. 

Getting the Results

The results from a pelvic ultrasound usually take around 1 to 2 weeks, but may be sooner. Patients can discuss any question or concerns before, during or after their scan, or at their results appointment. 

Costs

A private pelvic ultrasound will cost between £150 and £200. 

Get a Pelvic Ultrasound

If you have pelvic pain or unexplained bleeding from the vagina or the rectum, speak to your GP about getting a referral for a pelvic ultrasound scan. Depending on your symptoms, you may have to wait a number of weeks or months. If you’d like to have a private assessment, book your private ultrasound scan with us today. 

FAQs

Does Pelvic Inflammatory Disease Show on Ultrasound?

Yes, a transvaginal ultrasound can be used to diagnose pelvic inflammatory disease. 

Can a Pelvic Ultrasound Detect Cancer?

Yes, a pelvic ultrasound scan can detect cancers affecting the organs of the pelvic cavity, including the bladder, rectum, uterus, ovaries and prostate. 

Can You Eat Before a Pelvic Ultrasound?

Yes, unless otherwise advised, you can eat normally before a pelvic ultrasound. 

Does a Pelvic Ultrasound Show the Bladder?

Yes, a transabdominal ultrasound will show the bladder, and any potential bladder abnormalities. 

Does a Pelvic Ultrasound Show the Bowel?

A pelvic ultrasound will show the end of the large bowel, called the rectum. 

References 

Radiological Society of North America (RSNA) and  American College of Radiology (ACR). (n.d.-e). Pelvis Ultrasound. Radiologyinfo.org. https://www.radiologyinfo.org/en/info/pelvus

Professional, C. C. M. (2025, February 7). Pelvic Ultrasound. Cleveland Clinic. https://my.clevelandclinic.org/health/diagnostics/4997-pelvic-ultrasound

Pelvic Ultrasound. (2021, August 8). Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/pelvic-ultrasound

Morgan, K. K. (2024, April 29). Pelvic ultrasound: purpose and results. WebMD. https://www.webmd.com/women/what-is-a-pelvic-ultrasound

Mfa, J. H. M. M. (2018, September 17). What is a transvaginal ultrasound? Healthline. https://www.healthline.com/health/transvaginal-ultrasound

Radiological Society of North America (RSNA) and  American College of Radiology (ACR). (n.d.-f). Sonohysterography. Radiologyinfo.org. https://www.radiologyinfo.org/en/info/hysterosono

Endoanal ultrasound. (n.d.). Chelsea and Westminster Hospital NHS Foundation Trust. https://www.chelwest.nhs.uk/your-visit/patient-leaflets/imaging/endoanal-ultrasound