From the Research
For beginners performing hysteroscopy, the vaginoscopic approach (also known as the "no-touch" technique) is the recommended entry technique. This approach involves inserting the hysteroscope directly into the vagina without using a speculum or tenaculum, and then advancing it through the cervical canal into the uterine cavity under direct visualization. The procedure typically begins with distending the vagina with saline or another distension medium, allowing visualization of the cervix, followed by gentle advancement of the hysteroscope through the external os, cervical canal, and internal os.
Key Considerations
- The vaginoscopic approach is particularly suitable for beginners because it causes less patient discomfort, reduces the need for cervical dilation in many cases, and minimizes the risk of creating false passages.
- To optimize success, beginners should use a small-diameter hysteroscope (typically 3-5 mm), maintain steady distension pressure (80-100 mmHg for saline), and advance the scope slowly while keeping the cervical canal centered in the visual field.
- The vaginoscopic approach is preferred over traditional techniques because it reduces procedural pain, decreases the need for anesthesia, and generally results in higher patient satisfaction while providing the same diagnostic accuracy, as supported by studies such as 1.
Supporting Evidence
- A systematic review of the effect of the vaginoscopic approach on pain during outpatient hysteroscopy found that this method significantly reduces the pain experienced by patients compared to traditional techniques using a vaginal speculum 1.
- Other studies, such as 2 and 3, also highlight the benefits of the vaginoscopic approach in terms of patient comfort and procedural success.
- The most recent and highest quality study, 1, confirms the vaginoscopic approach as the preferred method for reducing pain and improving patient satisfaction during hysteroscopy.