Vaginoscopy “No Touch” Technique: A Feasible Alternative to Paracervical Block for in Office Hysteroscopy [34E]

Abstract

INTRODUCTION: Hysteroscopy allows direct visualization of the uterine cavity. Traditionally, in office hysteroscopy is performed using a speculum and tenaculum to hold the cervix. However, the emergence of smaller diameter hysteroscopes along with the vaginoscopy no touch technique without the need of speculum or tenaculum has contributed for the procedure to be done in the office setting without the use of analgesia. This study reviews our experience of in office hysteroscopy using the vaginoscopy "no touch" approach. METHODS: Retrospective chart review of 22 in office hysteroscopies performed without analgesia using the vaginoscopy “No touch” technique from June 1, 2017 to January 31, 2018. Patients received 200 mcg of oral Misoprostol 30 minutes before the procedure. Data gathered included age, body mass index, prior vaginal deliveries, and pain during the procedure. Success was measured as the ability to enter the endometrial cavity and perform the expected procedure. RESULTS: The median age 45 SD ±10.0 and BMI of 26.9 SD ±4.4. Hysteroscopic indications were: 2 (9.1%) postmenopausal bleeding, 5 (22.7%) retained IUD, 7 (31.8%) for suspected polyp, 8 (36.4%) for abnormal uterine bleeding. Of the 22 procedures, 18 were successful completed (80%). The median pain on VAS scale reported immediately after the procedure was 3.8 SD ±0.8 All four of the unsuccessful procedures were in postmenopausal females, two of which due to severe cervical stenosis. There were no complications. CONCLUSION: In office hysteroscopies using the vaginoscopy “no touch” technique is a feasible and safe procedure. We recommend adopting this innovative, painless technique.

Outcome comparison between vaginoscopy and standard hysteroscopy: A retrospective cohort study

“…4 Thus, vaginoscopy has been suggested as a standard practice to evaluate the uterine cavity in outpatient hysteroscopy. 6 In a randomized trial, Smith et al 2 reported pain scores of 42.7 and 46.4 (maximum of 100) for vaginoscopy and standard hysteroscopy, respectively ( p = 0.02). Garbin et al 7 reported that the VAS scores (maximum of 10) was lower for vaginoscopy than for standard hysteroscopy (0.5 vs 2; p < 0.001).…”

Vaginoscopy

“…Vaginoscopy by 'no-touch technique' is a feasible and safe technique. It is recommended to adopt this painless, non-traumatic and innovative technique [2]. This technique is also used for women with intact hymen and adolescent girls with abnormal vaginal discharge and abnormal uterine bleeding without damaging the intact hymen [3,4].…”