Unpopular yet Invaluable: The Role of Transrectal Ultrasonography in Evaluating Gynecological Pathologies

Abstract

Background: The popular and sensitive transvaginal sonography (TVS) is not always applicable for evaluating pelvic organs in some women such as those with intact hymen (IH) or with endovaginal lesions. This study reviewed gynecologic conditions where transrectal sonography (TRS) was used as an alternative for TVS. Materials and Methods: This retrospective study reviewed TRS reports and images of women who had complementary TRS following equivocal initial transabdominal gynecological scan. All scans were carried out in a tertiary radiodiagnostic clinic in South West Nigeria over an 18-month period (April 2023 to October 2024). Relevant published English literatures comparing the sensitivity/image quality of TRS and TVS were also presented. Results: Among the 16 cases retrieved, 10 (62.5%) had IH, whereas 6 (37.5%) had no IH (NIH); the median age (interquartile range) for the two groups were 20 (18–28) years and 64 (44–69) years, respectively. Major indications for TRS among the IH were abnormal uterine bleeding (40.0%), primary amenorrhea (30.0%), and menorrhagia/severe dysmenorrhea (20.0%), whereas pelvic organ prolapse (66.7%) and TRS-guided intrauterine device (IUD) removal (33.3%) were the indications among the NIH. The most common TRS findings among the IH group included polycystic ovarian morphology (50.0%), absent or hypoplastic uterus/streak ovaries (30.0%), and submucous uterine fibroid nodules (30.0%), while the 50% of the NIH women had cystoceles and 33.3% had successful IUD removal under TRS-guidance. Conclusion: When it is not possible to use TVS in women with gynecological complaints, TRS is a suitable and inexpensive alternative method for evaluating the endometrium and adnexal structures.