Transvaginal Scan

Patient Information

Your doctor has requested us to perform a transvaginal ultrasound. It is important that you understand the
procedures that is associated with this examination:

Definition of Terms

  • The ultrasound transducer will be placed in the vagina (the probe is sterilised)
  • The transducer will be introduced with a latex / non latex type covering
  • It will be necessary to move the transducer from side to side, up and down and may be swiveled to obtain images
  • If you prefer, you may insert the transducer yourself, otherwise the person conducting the examination will do this
  • A third person may be present during the examination acting as a chaperone, if required by the sonographer or yourself
  • You may request the examination to be stopped at any time during the examination

Patient Consent

  • I acknowledge that the examining doctor / clinician has explained the proposed procedure
  • I have been provided with information regarding the proposed procedure
  • I understand the risks and complications involved in the procedure
  • I understand I have the right to change my mind at any time including after I have signed this form but, preferably following discussion with my doctor
  • I have been provided the opportunity to have any questions answered
  • I therefore give my consent for the transvaginal examination to be performed