2170 Vaginoscopy: A Minimally Invasive Approach to Hysteroscopy

Abstract

Video Objective To demonstrate the vaginoscopic approach to hysteroscopy. Setting The patient is a 35-year-old G0 with a history of endometrial polyps previously treated with hysteroscopic resection who presented with recurrent intermenstrual spotting and evidence of endometrial polyp on ultrasound. She presented for hysteroscopic polypectomy in the outpatient setting. Interventions The patient underwent vaginoscopy with hysteroscopy under monitored anesthesia care using a 5-mm operative hysteroscope. Manual coaptation of the labia allowed for vaginal distention, and the posterior approach was used to locate and enter the external cervical os without the use of a speculum or tenaculum. Full survey of the endometrial cavity was completed and a small area of polypoid tissue was sampled. Conclusion Vaginoscopy is recommended as the standard approach to hysteroscopy by the Royal College of Obstetricians and Gynecologists and the French College of Gynecologists and Obstetricians because of its many benefits over traditional hysteroscopy, including improved patient comfort and reduced need for anesthesia. Vaginoscopy may allow for hysteroscopic evaluation of patients otherwise thought to be poor candidates because of intolerance of a speculum examination, vaginal atrophy and/or cervical stenosis, as seen in pediatric, virginal and postmenopausal patients. Vaginoscopy may also afford benefits over traditional hysteroscopy by allowing direct inspection of the vagina and cervix, as well as management of cervical stenosis under direct, magnified visualization. Despite these benefits, uptake of this method has not been widespread in the United States, likely because it is not frequently taught. This video demonstrates a vaginoscopic procedure with adequate vaginal distention and a posterior approach to localization of the cervical os with the aim of increasing provider comfort and adoption of this approach.