The use of high-frequency ultrasonography in the assessment of selected female reproductive structures: the vulva, vagina and cervix

Marian Stanisław Migda, Michał Migda, Rafał Słapa, Robert Krzysztof Mlosek, Bartosz Migda, Marian Stanisław Migda, Michał Migda, Rafał Słapa, Robert Krzysztof Mlosek, Bartosz Migda

Abstract

Introduction: High-frequency ultrasonography enables visualization the layered structure of the skin and shows the epidermis, dermis, subcutaneous tissue and skin appendages: hair follicles, sebaceous glands, sweat glands and blood vessels. The aim of this study was to apply high-frequency ultrasonography to evaluate the structure of the vulva, vagina and cervix, and to describe their anatomy in ultrasound.

Material and method: The examinations were conducted with the use of high-frequency probes: DermaView 48 MHz and Episcan 50 MHz, by three operators experienced in performing classical ultrasound scans (with 30-, 10- and 9-year experience). The study involved 50 women aged 20-80 years who reported for a periodical gynecological check-up and presented no symptoms within the reproductive system.

Results: In this study, the individual layers of the skin in the area of the mons pubis, labia majora (together with hair follicles and sweat glands) and labia minora were successfully visualized in all the patients. The subepidermal low-echogenicity band was seen in the area of the mons pubic and labia majora in 40 cases. This concerned 100% of women who underwent cosmetic skin treatments. In all the patients, HFUS demonstrated the layered structure of the anterior and posterior vaginal walls, the walls of the urinary bladder and rectum, layers of the vaginal portion of the cervix and the external opening of the cervix.

Conclusions: High-frequency ultrasonography offers new quality of vulvar, vaginal and cervical imaging. It can be used for evaluation of the vulva and vagina, and confirms their layered structure. It also enables accurate measurements of the thickness of the vulvar epidermis and dermis as well as the thickness of the vaginal walls.

Keywords: cervix; high-frequency ultrasonography; ultrasound; vagina; vulva.

Conflict of interest statement

Conflict of interest Authors do not report any financial or personal connections with other persons or organizations, which might negatively affect the contents of this publication and/or claim authorship rights to this publication.

© Polish Ultrasound Society.

Figures

Fig. 1.
Fig. 1.
High-frequency ultrasound.A.DermaView with a mechanical transducer of 48 MHz andB.Episcan with a mechanical transducer of 50 MHz
Fig. 2.
Fig. 2.
Histopathological image of the skin of the pubic mound(A)with the corresponding HFUS image(B). Epidermis (small arrow), dermis (large arrow), Episcan, transducer of 50 MHz
Fig. 3.
Fig. 3.
A.HFUS of the skin of the labia majora and minora with visible hair (asterisk) and marked hair follicle (large arrow).B.An image of the labia majora with removed hair and a visible subepidermal low-echogenicity band (SLEB, thick arrow), sweat gland (arrow head) and blood vessel (small arrow)
Fig. 4.
Fig. 4.
A.HFUS of the external urethral orifice in a multiparous woman with a visible periurethral Skene’s gland (small arrow), andB.the external urethral orifice in a primiparous woman (large arrow) with visible periurethral folds (asterisk)
Fig. 5.
Fig. 5.
HFUS. Interepithelial boundary – Hart’s line (arrow)
Fig. 6.
Fig. 6.
HFUS of the labia minora with a “gel pad” (arrow)
Fig. 7.
Fig. 7.
Clitoris with the clitoral hood in HFUS (arrow)
Fig. 8.
Fig. 8.
HFUS of the anterior vaginal wall (small arrow: mucosa; thick arrow: muscle layer; long arrow: adventitia) with the adjacent wall of the urinary bladder (area between asterisks)
Fig. 9.
Fig. 9.
HFUS of the posterior vaginal wall with the adjacent rectal wall. Mucosa of the posterior vaginal wall (arrow), muscle layer (large arrow), adventitia (thick arrow). The layered structure of the intestine is visible between asterisks
Fig. 10.
Fig. 10.
Vaginal ultrasound. A. Transperineal examination. B. Transabdominal examination. PM, V.UR – urinary bladder, V – vaginal wall, R, RE – rectum, cervix – cervix uteri. Markers show the anterior and posterior vaginal walls
Fig. 11.
Fig. 11.
Echostructure of the vaginal portion of the cervix in HFUS with a visible muscle layer (between asterisks) and blood vessels located underneath. The non-keratinizing stratified squamous epithelium (arrow) is covered with reflections from the transducer shield in HFUS
Fig. 12.
Fig. 12.
External opening of the cervix in HFUS (arrow)
Fig. 13.
Fig. 13.
Cervical canal in HFUS (between arrows)
Fig. 14.
Fig. 14.
Nabothian cysts in the cervix in HFUS (arrows)
Fig. 15.
Fig. 15.
Cervix in transabdominal ultrasound (arrow: external cervical opening; between asterisks: cervix), PM: urinary bladder
Fig. 16.
Fig. 16.
Cervix in transvaginal ultrasound, the internal and external opening (large arrows); the cervical canal visible between arrows, small arrow: Nabothian cyst

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