Informed Patient Consent For Transvaginal Ultrasound Scan

Patient Information

You have been referred to us to perform an ultrasound scan. Gynaecological ultrasound and some early pregnancy ultrasound scans are routinely performed using a transvaginal probe technique. This technique is used to view the pelvic anatomy optimally, as the ultrasound probe can transmit safe ultrasound waves more directly to the pelvic area. In later stages of pregnancy, it may be advised to perform a transvaginal ultrasound scan to have a closer look at a baby's anatomy, or to assess the maternal cervix.

There is no clinical risk associated with performing a transvaginal ultrasound scan. Transvaginal ultrasound scans can safely be performed during menstruation and episodes of vaginal bleeding.

It is important that you understand the procedure that is associated with this examination.

  • The ultrasound transducer will be placed in the vagina (the probe is prepared using high grade medical disinfectant).
  • The transducer will be introduced with a latex / non latex type covering and sterile ultrasound gel.
  • It will be necessary to move the transducer from side to side, up and down and may be swivelled to obtain ultrasound images of your pelvic anatomy.
  • 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 procedure.

Do you have an allergy to latex?

Do you require a chaperone?

Contraindications (i.e. Virgo intacta)

  • If you are a virgin (Virgo intacta; hymen intact), guidance determines that transvaginal ultrasound scans are clinically contraindicated. If you have discussed this concern with your referrer and wish to proceed with a transvaginal ultrasound scan, this type of examination can be performed.
  • I am aware that transvaginal ultrasound scans are contraindicated for virgins. I have discussed this with my referring doctor and give informed consent for the doctor/sonographer to perform a transvaginal ultrasound scan.

Patient Consent

  • I acknowledge that my referring doctor/The Birth Company have 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 the contraindications for transvaginal ultrasound scans.
  • 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.

I consent to having a transvaginal ultrasound scan:

I consent that I am Virgo intacta, but I would like to proceed with the transvaginal ultrasound scan:

I do not give consent for a transvaginal ultrasound scan:

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137 Harley Street, London W1G 6BF
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Baker Street
Regent’s Park
Great Portland Street


Alderley Edge Medical Centre, Talbot Road, Alderley Edge, Cheshire, SK9 7HR
Nearest Overground Train Station

Alderley Edge