CHAPTER ONE

1.0 INTRODUCTION

1.1 BACKGROUND OF STUDY

Transvaginal sonography (TVS) is key to ovarian cancer screening. It is universally used either as the primary screening modality or as a second-line test following primary screening with serum CA 1251–4; although TVS is a relatively invasive procedure and potentially embarrassing for the woman, it is increasingly the routine investigation for assessment of pelvic conditions both in younger and in older patients. It is preferred over transabdominal sonography (TAS) as the pelvic organs are better visualized and, unlike TAS, women are not required to fill their bladder.

Previous studies looking at the acceptability of TVS have shown that most women find it acceptable. However, these studies were mainly in younger premenopausal women in an early pregnancy/obstetrics setting. To our knowledge, there are currently no published studies specifically exploring the experience of TVS in postmenopausal women, the population who will need to undergo annual scanning if ovarian cancer screening is found to have a mortality impact, or in women with postmenopausal bleeding for whom TVS is the primary line of investigation. In this older population, it is likely that women may experience increased discomfort because of atrophic changes resulting from a hypo-estrogenic status and find it more intrusive; some of these discomforts may be inform of pains.

The pain is caused by the passage of the aspiration needle through the vaginal wall and the ovary capsule, and by mechanical stimulation of the ovary. The process may be more painful if the ovaries have adhesions or if they are stuck for example in the pouch of Douglas, behind or on top of the uterus. Pain during oocyte retrieval is more intermittent than continuous (Zelcer et al., 1992). When evaluating if women are satisfied with their pain relief during oocyte retrieval, studies show that women rate the degree of satisfaction as high although the pain levels are also high (Kwan et al., 2005). Infertility and IVF treatment itself are major stressors (Baram et al., 2008, Anderheim et al., 2005, Holter et al., 2006). Particularly stressful events in an IVF cycle include waiting for the results of fertilization, waiting for pregnancy particularly after, one or more unsuccessful treatment cycles or a terminated pregnancy. It is to this regard that the study desired to examine the knowledge and perception of women transvaginal sonogrpahy.

1.2 STATEMENT OF RESEARCH PROBLEM

The transvaginal sonography is very important for the health of the women especially the pregnant women in area of determining the position and the performance of foetus.  But most ladies in Nigeria may have the fear of participating in tranasvaginal sonography maybe because of what they have been told concerning the transvaginal sonogrpahy as regard the unknown risks of performing Transvaginal Ultrasound; although it is a technique which uses sound waves to obtain pictures or images and there is no radiation involved. For instance if you are pregnant, there are no risks to the foetus (unborn baby) during transvaginal sonography. Also if you are pregnant and your waters have broken but you are not in labour (this is called premature rupture of the membranes) it is not advisable to have ultrasound due to a small increase in the risk of infection to your unborn baby.

1.3 AIM AND OBJECTIVES OF STUDY

The main aim of the research work is to examine the knowledge and perception of women transvaginal sonography. Other specific objectives of the study are:

1. to investigate on the attitude of women towards sonography
2. to determine the effect of illiteracy on the general acceptance of transvaginal sonography in Nigeria
3. to determine the effect of scanning procedure on the level of anxiety among women during transvaginal sonography
4. to determine the effect of the painful insertion and rotation of probe on the participation in transvaginal sonography exercise among women
5. to proffer solution to the above stated problem

1.4 RESEARCH QUESTIONS

The study came up with research questions so as to ascertain the above stated objectives of the study. The research questions for the study are:

1. What is the attitude of women towards sonography?
2. What is the effect of illiteracy on the general acceptance of transvaginal sonography in Nigeria?
3. What is the effect of scanning procedure on the level of anxiety among women during transvaginal sonography?
4. What is the effect of the painful insertion and rotation of probe on the participation in transvaginal sonography exercise among women?

1.5 STATEMENT OF RESEARCH HYPOTHESIS

Hypothesis 1

H0: scanning procedure has no significant effect on the level of anxiety among women during transvaginal sonography

H1: scanning procedure has significant effect on the level of anxiety among women during transvaginal sonography

Hypothesis 2

H0: the painful insertion and rotation of probe does not affect participation in transvaginal sonography exercise among women

H1: the painful insertion and rotation of probe affects the participation in transvaginal sonography exercise among women

1.6 SIGNIFICANCE OF STUDY

The study on the knowledge and perception of women transvaginal sonography will be of immense benefit to the health organizations in Nigeria, the women and other researchers that desire to carry out similar research on the above stated topic as the findings of the study will educate the women, the health care workers and other researchers on transvaginal sonography, the benefit of transvaginal sonography, and the factors affecting the perception and attitude of women towards the participation in transvaginal sonography. Finally the study will contribute to the body of existing literature and knowledge in this field of study and provide a basis for further research

1.7 SCOPE OF STUDY

The study on the knowledge and perception of women transvaginal sonography will cover on transvaginal sonography, the benefit of transvaginal sonography, and the factors affecting the perception and attitude of women towards the participation in transvaginal sonography

1.8 LIMITATION OF STUDY

Financial constraint- Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview).

Time constraint- The researcher will simultaneously engage in this study with other academic work. This consequently will cut down on the time devoted for the research work

1.9 DEFINITION OF TERMS

Transvaginal sonography: “Transvaginal” means “through the vagina.” This is an internal examination