Radhika was in her mid-twenties when she visited a gynaecologist in Bengaluru for her painful periods and was recommended an ultrasound. A radiologist in a multispeciality hospital conducted an abdominal ultrasound, but couldn't see anything clear enough to detect.

He told her a transvaginal ultrasound would reveal a lot more, but he wouldn't be able to do it for her as she was unmarried.

Radhika did not go to any other hospital. She continued to experience painful periods and painful intercourse for the next 10 years. In 2022, after losing two pregnancies in two years, she got fertility tests done in the UK, where she now resides. A transvaginal ultrasound revealed that her uterus was tilted and had signs of adenomyosis – something she suspects was an issue all these years.

“I was more angry than relieved,” she told Newslaundry. “I’ve had to suffer from painful periods and painful sex for a long, long time without understanding why. I’m so angry at the bullshit construct of virginity and the heavy price we pay for it.”

Radhika’s struggle to get a transvaginal ultrasound isn’t an isolated incident. Women across India are denied these procedures when they are not married, sometimes even in cases where a gynaecologist has recommended one. 

A transvaginal ultrasound is a pelvic ultrasound that detects abnormalities in a woman’s ovaries, tubes, cervix, endometrium, bladder, fallopian tubes, or pelvic areas. It looks at organs from inside the vagina using a narrow, wand-shaped device that uses sound waves to provide detailed imaging. A condom is put over the device or probe and lubricated. It gives a much clearer view of the pelvic organs as compared to an abdominal ultrasound. 

Newslaundry spoke to 12 women across Delhi, Mumbai, Bengaluru and Gujarat who said they were denied transvaginal ultrasounds since they are unmarried. In some cases, they had to argue with their radiologists to get it done, or get their gynaecologists to intervene. 

In a tier-2 city in Gujarat, Anjali was in her 20s when she was denied a transvaginal ultrasound by a radiologist at a clinic. She eventually never got the procedure done. 

“There is no repercussion for doctors misdiagnosing or failing to diagnose something,” said Anjali, who did not want Newslaundry to reveal the name of the city due to anonymity concerns. “Our issues don’t end when a doctor says no – we have to keep living our lives with them with nobody to help us. It is very frustrating to know there’s a procedure that can tell me I have PCOS, but it won’t be done on me.”

‘He said it was against his own laws’

The median Indian woman’s first sexual experience is actually not as high as one would think. According to the latest National Family Health Survey data, it’s 18.9 years. The data indicates that one in 10 women in their late twenties have not yet had sex.

But the NFHS also noted that a woman’s first sexual experience is closely linked to the age of marriage. As education increases, so does the average age. Data shows that urban women have sex for the first time later than their rural counterparts.

Doctors use the “are you married” question as a substitute for directly asking women if they are sexually active.  But studies have noted that due to the extensive gap between puberty and marriage, there is a higher chance that young women will have sexual relationships before marriage. Data also shows that a woman’s higher education level plays a big role in her getting married later rather than sooner. 

Saumya’s experience of visiting a south Delhi clinic, which was rated 4.8 stars on Google, cost her dearly. After a long conversation at the reception, the clinic billed her and sent her inside. But the radiologist refused to do the transvaginal ultrasound and told her it was “against the law”.

When Saumya, 24, told him that article 21 of the constitution states that being denied medical treatment is a violation of the right to life, the radiologist said it was against the Pre-Conception and Pre-Natal Diagnostic Techniques Act – which isn't true. Saumya then told him it doesn’t say anywhere that he could not perform a transvaginal ultrasound on an unmarried woman, but he told her it was against “his own laws”.

“To clear his inhibitions, I told him to not think that he was taking away my virginity as I was sexually active so he could relax. He still refused, saying he won’t do it to unmarried women,” said Saumya, who was made to do an abdominal scan instead.

The scan revealed irregularities but her doctor couldn’t specifically treat the issue because it didn’t offer the level of detail that a transvaginal ultrasound would have given. 

Saumya still hasn’t got the ultrasound done and is contemplating filing a legal case against the clinic. “They deny you a certain medical service and spread misinformation about the law which really bothers me as most people won’t be able to stand up for themselves,” she said. 

Agni was 24 when her gynaecologist recommended getting a transvaginal ultrasound. Agni went to a clinic in Delhi’s GK II. 

“I was asked if I’m married. After I told them I’m not, the nurse said they can’t do the ultrasound,” she said. “She called the doctor who told me the ultrasound was not meant for unmarried women as there will be an issue when I’m married. I told them that if they’re worried about my virginity, there’s no need to be.”

She added, “Even if the girl is a virgin, isn’t saving her life more important than saving the construct of a hymen?”

Back at the clinic, Agni insisted on getting the ultrasound done. The clinic reluctantly agreed, but allegedly made her sign an affidavit saying the status of her vagina would be “altered” and that she would take full responsibility for it. She no longer has a copy of the affidavit. 

A radiologist from an upmarket suburb in Mumbai told Newslaundry, “We don’t do ultrasound on unmarried women as, in our country, it is a taboo. It’s not a law. But everyone’s approach is different. And since I am at the other side of my career now, I’d rather let a patient go than let it lead to an unnecessary issue.”

According to him, the concern is that a patient’s future husband will create a scene – not just with the woman but with the doctor too. But if an unmarried woman insists, he said she and a relative – any relative – can sign a consent form. He also claimed gynaecologists are required to state in writing that the ultrasound is needed.

Some women had more bizarre stories. 

Heena was 23 and pregnant when she was refused a transvaginal ultrasound in Bengaluru because she was unmarried, even though she’d clearly had sex. 

In Delhi, Priya had a 10-year-old daughter and was nearly 40 when a lab asked for her husband’s signature to “consent” to the ultrasound. Priya, who is divorced, insisted that the lab submit in writing that it wouldn’t do the ultrasound without her husband’s consent. The lab then reluctantly performed the ultrasound.

“If you don’t have a husband, are you expected to not have an issue with your vagina?” Priya asked. “I am a fully functioning adult and I am signing a consent form anyway. They are robbing you of your autonomy. It’s your body, it’s your decision – the matter should end there.”

‘Every single person there was judging me’

Dr Mugdha Raut, a gynaecologist in Mumbai, told Newslaundry a transvaginal ultrasound provides a much better diagnosis as the probe is closest to the pelvic organ and has clear visualisation. 

“I recommend the ultrasound when a woman is sexually active,” she said. “Nowadays, women get married late and are sexually active before that. We have to accept it rather than treat it like a taboo. We don’t need to be judgemental about it. Things are changing and we need to be accepting towards it.” 

Importantly, the denial of these ultrasounds relies on patriarchal ideas of virginity and sex, and unreliable theories about hymens being indicators of sexual activity. None of these are more important than a woman’s health.

In Delhi, Isha visited a radiologist on her gynaecologist’s recommendation after 24 days of continuous bleeding. The radiologist insisted on doing an abdominal ultrasound instead of a transvaginal one, and she agreed. The results weren’t clear enough.

Meanwhile, her bleeding didn’t stop and her gynaecologist suspected an ectopic pregnancy. The gynaecologist spoke to the radiologist and insisted on a transvaginal ultrasound. Isha said she was then grilled for personal details, including her parents’ names and her Aadhaar card details. She also had to sign a no-objection certificate stating that she had been prescribed the ultrasound by her doctor, along with her age and the fact that she was unmarried. 

She said the receptionist at the radiologist’s clinic told her “they don’t usually do it for unmarried women” but were “considering her case” since her doctor had insisted. Meanwhile, sundry admin personnel debated what to do.

“A group of men, who have no idea what it’s like to have a uterus, are discussing whether or not I should get this examination done, which is very essential for my life,” Isha said. “Every single person there was judging me. They made a huge scene about an unmarried woman coming to do a transvaginal ultrasound.”

Isha was panicking and crying at this point, she said. So, she left and returned later with her male partner. She was put in an examination room but the radiologist still refused to perform the ultrasound.

“I’m lying on the bed, wearing hospital clothes having removed my underwear. I told the radiologist to just be careful as I’m bleeding. And then he refused to perform it on me,” she said. “He called two young interns to do it. He guided them but they didn’t seem to know what they were doing. They were whispering and giggling throughout.”

Jiya, 26, was also left lying in a clinic in Delhi when the radiologist didn’t believe she, as an unmarried woman, had been prescribed a transvaginal ultrasound.

“He called the gynaecologist to ask if she had actually prescribed the transvaginal ultrasound,” Jiya said. “They did the ultrasound once they received confirmation from the gynaecologist.”

The women Newslaundry spoke to said the ultrasound is invasive, uncomfortable and, for a lot of them, painful. This makes it all the more important for it to be done sensitively, and have it explained to patients before it takes place.

Dr Anjali Wagh, a gynaecologist in Mumbai said that radiologists must explain the ultrasound in detail and in the respective local language to the patients. She said having woman sonographers do the procedure could also ensure more comfort. 

“Sometimes when I am looking for something specific, I recommend a transvaginal ultrasound for its accuracy. Sometimes, women may not be comfortable with this ultrasound, even married women. But if she agrees and gives her consent, then there should be no issue,” she said.

*All names of patients changed to protect identities.

Update on March 21: A typo has been fixed in Agni’s quote; ‘saving her life’ was misspelled as ‘saying her life’.