Deep Endometriosis Ultrasound Scan

Endometriosis occurs in approximately 10-15% of women in the reproductive age range and can cause pain symptoms, infertility and decreased quality of life. 

Endometriosis is a gynaecological condition where endometrial tissue implants in locations outside the uterus, usually in the lower abdomen. There are three types of endometriosis: superficial, ovarian, and the most severe form, deep endometriosis. 

Endometriosis can grow on the uterus, ovaries, Fallopian tubes, uterine ligaments, bowel, bladder, ureters and appendix. Endometriosis causes scar tissue to form between the pelvic organs, such as the bowel and uterus (called "pouch of Douglas obliteration").

Symptoms suggestive of endometriosis include: 

• very painful periods
• chronic pelvic pain
• pain with sexual intercourse
• lower back pain
• painful bowel movements
• painful urination
• infertility

Other endometriosis symptoms may include irregular vaginal bleeding, constipation and diarrhea. 

Painful bowel movements and blood in the stool are symptoms that may suggest the presence of deep bowel endometriosis.

A basic pelvic ultrasound can detect ovarian endometriosis, or endometriomas, but this type of scan does not assess for endometriosis nodules located deeply within the pelvis or for pelvic adhesions (scar tissue between organs).  

Deep endometriosis nodules can be diagnosed with an advanced pelvic ultrasound examination for endometriosis called gel sonovaginography or "gel SVG".  During this scan, extra ultrasound gel is placed into the vagina prior to performing the scan, to aid with the examination of the pelvic structures (bowel, bladder, ureters, vagina, uterosacral ligaments).

A thorough assessment for adenomyosis is also performed during the endometriosis scan.

In experienced hands, a SVG scan is very accurate at predicting the presence of pelvic deep endometriosis nodules and/or pelvic adhesions. If you have a normal endometriosis scan, there is <95% chance you will have deep endometriosis. 

A gel SVG deep endometriosis scan is recommended for women with ongoing symptoms suggestive of endometriosis, such as: 

• chronic pelvic pain
• significant period pain
• painful intercourse
• bladder/bowel symptoms suggestive of endometriosis
• history of previous endometriosis with recurrent symptoms
• 'chocolate' ovarian cysts (endometrioma) seen on a basic pelvic ultrasound scan

The gel SVG endometriosis scan allows for the diagnosis of deep endometriosis and pelvic adhesions, which is important not only for planning your management, but also for understanding the cause of your symptoms.

The gel SVG scan predicts the location and severity of endometriosis, which helps your GP or Gynecologist to decide what type of treatment is best for you, as well as allows for improved surgical planning.

You will be asked to empty your bladder for the scan. 

The SVG scan is performed with a vaginal ultrasound wand, and there can be some mild discomfort during the scan (especially if you have a history of pelvic pain or painful intercourse).  

If you have a history of pelvic pain, please take some painkillers (such as panadol or nurofen) about an hour before your appointment.