Transrectal and 3D Transabdominal Ultrasound Compared to Vaginoscopy in Diagnosing Virgins With Genital Lesions
Transrectal and 3D Transabdominal Ultrasound Compared to Vaginoscopy in Diagnosing Virgins With Genital Lesions
This study is to compare the feasibility and test performance of different 3D pelvic
 ultrasound and Transrectal ultrasound in the detection of local lesions in the uterus ,
 cervix and vagina compared to the final diagnosis confirmed by vaginoscopy as a golden
 standard modality of diagnosis in Virgin Patients
Virginity is a very private issue; saving or losing it is a matter of choice depending on
 age, ethnicity, religion, or simply personal decision. Post-pubertal teenage girls, religious
 women such as nuns, and women in some countries tend to be virgin. This situation must be
 respected by medical professionals. But when a vaginal examination is necessary, virginity
 might be a limiting factor for the gynecologist in diagnosis and treatment.

 Vaginal discharge or bleeding is the symptom most commonly reported by adolescent girls that
 are referred for gynecologic problems. The most common cause of vaginal discharge at these
 ages is infection due to a hypo-estrogenized vagina, although other potential causes, such as
 congenital anomalies of the genitalia, trauma, foreign bodies, sexual abuse, and malignant
 disease, must also be excluded. With regard to virginity and childbearing possibility in the
 future, a careful approach is of paramount importance.

 Hymenal tissue does not easily tolerate vigorous manipulation and wide movements. When
 needed, potential hymeneal disruption may be discussed with mature women or with the parents
 of adolescent girls for the sake of correct diagnosis and treatment; but in general, they are
 highly resistant to that.

 When a reproductive tract examination or transvaginal operation must be arranged for a
 virgin, the operator faces a challenge and may hesitate to utilize hysteroscopy, which can
 result in a delayed diagnosis or improper treatment.

 The most common indication for hysteroscopy is abnormal vaginal bleeding in virginal patients
 and has been widely used for uterine cavity examination and management. Although the
 possibility of hymen preservation is high, virgins are highly resistant to this procedure.
 This may be due to a belief that the procedure causes disruption of virginity and worries
 associated with their future partners.

 The approach by vaginoscopy and hysteroscopy via a hysteroscope provides a safe and
 non-traumatic method in assessing the reproductive organs because the scope of the
 hysteroscope is advanced into the vagina without a speculum or tenaculum. Distension of the
 vaginal wall by distension medium can in turn provide a clear endoscopic view.

 These considerations have made clinicians opt for these procedures in assessing pathologies
 of the vagina, the surface of the cervix, the cervical canal, and the intrauterine cavity and
 other developmental anomalies of the sex organs in patients. Furthermore, the entire
 procedure can be undertaken without disrupting integrity of the hymen, whereas the
 traditional method requires the use of retractors and, therefore, disrupts this integrity.

 Although hysteroscopy can improve diagnosis and thereby improve quality of life, virgins may
 decline this procedure. Patients with delayed diagnosis and management in some uncommon but
 serious situations, such as endometrial malignancy, are life-threatening.

 So far, only a few reports have discussed the protection of hymen integrity in hysteroscopy,
 and the physical and psychological impacts of this surgery in virgins are not conclusive
 .This is an important issue that gynecologists encounter, but which has seldom been
 discussed. Intravenous sedation is recommended to reduce the patient's anxiety and pain,
 avoid vasovagal reaction, relax the buttock muscles and reduce the risk of hymenal trauma .
 Unlike operative hysteroscope, loop electrode cannot be employed in mini-hysteroscope;
 therefore, for some diseases like submucous leiomyoma or uterine septum, mini-hysteroscopy is
 not therapeutically beneficial, and this should be explained to the patients in advance.
 Adequate preoperative counseling is also necessary to emphasize the importance of the
 procedure and to lessen their anxiety.

 In virgin patients when vaginal examination cannot be done ultrasonography is a useful
 adjunct to inspection of the external genital organs.

 Currently there are three accepted and more or less widely used modalities to image the
 contents of the female pelvis. Transabdominal sonography (TAS) was the first to be used and
 is still the most widespread.

 By using a full urinary bladder as an acoustic window, ovaries, uterus, and superior vagina
 can be clearly examined using transabdominal (TA) ultrasonography.

 Transvaginal sonography provides clear images of the region of interest, provided that the
 targeted organ is within the focal range of the probe, and that the probe is placed in
 proximity to the organ in question .

 Agenesis of the vagina, a virginal introitus and the fear of introducing infection such as in
 the case of premature rupture of the membranes are some of the more common situations in
 which Transvaginal ultrasound is not possible or is relatively contraindicated.

 In such cases introducing a commercially available vaginal probe through the anal sphincter
 into the rectum seems to be a reasonable alternative to image the female pelvic structures
 within 'reach' of the probe. We present a study to compare TAS and transrectal sonography
 (TRS) in a group of patients in whom Transvaginal ultrasound was not possible.

 Transrectal sonography (TRUS) has been widely used in men as a diagnostic tool for prostate
 cancer. Its value in the management of disorders of the lower urinary tract in women and as
 an alternative to intraoperative gynecologic sonography has also been documented . Case
 reports in the radiological literature attest to the fact that it has been used to guide
 drainage of inflammatory pelvic collections.
Inclusion Criteria:

 -  Virgins complaining of Abnormal vaginal bleeding, abnormal discharge , pelvic pain

 -  Virgins with Suspected genital tract lesion by examination

 -  Virgins with Suspected genital tract lesion by pelvic ultrasound

 Exclusion Criteria:

 -  Sexually Active Patients

 -  Suspected or documented Pregnancy

 -  Virgin patients with no suspected uterine, cervical or vaginal lesion by pelvic
 ultrasound

 -  Patients unable to communicate effectively