Vaginoscopic approach to outpatient hysteroscopy: a systematic review of the effect on pain

Background Vaginoscopy, also known as the 'no-touch' technique, is an alternative method for performing hysteroscopy without the need for a vaginal speculum to view the cervix or cervical instrumentation to grasp and steady the cervix. Objective To examine the effect of a vaginoscopic approach to outpatient hysteroscopy on the patients' experience of pain, compared with a traditional approach using a vaginal speculum. Search strategy MEDLINE, EMBASE, CINAHL and the Cochrane Library were searched for relevant articles. No filters or restrictions were placed on the searches. Selection criteria Randomised controlled trials (RCTs) that assess pain when comparing the vaginoscopic technique versus a traditional hysteroscopy in the outpatient setting. Data collection and analysis Two reviewers independently selected trials. Data were abstracted on quality, characteristics and results. Meta-analyses were performed using the random-effects model to calculate the standardised mean difference (SMD). Main results There were six trials (2851 participants). Data from four of these were meta-analysed, and we found that the use of the vaginoscopic approach to hysteroscopy was less painful than using the traditional technique (SMD -0.44, 95% CI from -0.65 to -0.22, I2 = 58%). There was no significant difference in the number of failed procedures between groups (P = 0.38). Author's conclusions The vaginoscopic approach to outpatient hysteroscopy is successful and significantly reduces the pain experienced by patients during the procedure, compared with traditional techniques using a vaginal speculum. Vaginoscopy should become standard practice for endoscopic instrumentation of the uterine cavity in the outpatient setting.