2736 Vaginoscopy: An Underutilized Surgical Approach in Cases of Distorted Anatomy

Abstract

Video Objective To demonstrate the use of vaginoscopy in difficult cases of distorted anatomy. Setting Distorted anatomy of the female reproductive tract, such as a deep vagina, a stenotic cervix, or lower genital tract obstruction from mass effect, may make evaluation of the vagina, cervix, and endometrial cavity extraordinarily difficult. Vaginoscopy may be helpful in overcoming these anatomic challenges. Interventions This video demonstrates vaginoscopy in four case scenarios. In the first case, we demonstrate how vaginoscopy can be used to remove a malpositioned IUD in an obese patient, whose cervix and IUD strings could not be visualized with in-office speculum exam. The second case demonstrates evaluation of the vagina and endometrial cavity in a postmenopausal patient with vaginal atrophy and cervical stenosis. The third case focuses on IUD removal in a patient with a large rectal mass distorting the vaginal canal and subsequently blocking visualization of the IUD strings in-office. Finally, the fourth case demonstrates vaginoscopy in the case of a severely retroflexed uterus. Conclusion Vaginoscopy is a simple and effective technique that can improve visualization and access in complex cases resulting from anatomic distortion.