Cervix and Vagina

The vagina and cervix are best visualized with transabdominal sonography. Visualization of the cervix with the transvaginal probe requires that the probe be withdrawn into the distal vagina. Nabothian cysts are benign growths that can commonly be seen in the region of the cervix ( Fig 109-5). Gartner duct cysts are also benign and may be seen at the anterior and lateral walls of the vagina. Imperforate hymen causes primary amenorrhea, lower abdominal pain, and urinary symptoms during puberty. A tender lower abdominal mass may be palpable on physical examination and pelvic sonography will confirm that the vagina is filled with blood; this is called hematocolpos. A distended urinary bladder and a blood-filled distended uterus, or hematometra, may also be noted (Fig 109-22). Perineal examination will reveal a bulging hymen; incision and drainage are required.

Incised Hymen

FIG. 109-22. Hematometra. A large amount of hypoechoic blood (clot) is seen within the uterus. This can be seen with an imperforate hymen or as a postoperative complication of gynecologic surgery.

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