Pseudo Vaginoscopy: A Modified Vaginoscopy Technique for Outpatient Hysteroscopy in Cases with Difficult Access

Background: Outpatient hysteroscopy is a safe, reliable and cost-effective alternative to hysteroscopy under a general anaesthetic for the diagnosis of abnormal uterine bleeding. Objectives: The objective of this study was to introduce new technique of pseudo-vaginoscopy for better movement of hysteroscope and less procedural pain. Also to assess acceptability of patients for outpatient hysteroscopy when appropriate analgesia was given prior to the procedure. Methodology: A prospective study was conducted of 74 women attending for outpatient hysteroscopy at the West Cumberland Hospital over a period of one year. Selection criteria include very narrow and atrophic vagina and failed speculum examination in gynaecology outpatient clinics. Results: Of the women studied, 95.5% stated that they would recommend the procedure to friends in future, whilst 5.8% would not want to go through it again. The type of anaesthetic administered during the procedure seem to influence whether women would attend for outpatient hysteroscopy in future. Conclusion: Our pseudo-vaginoscopic approach allows more freedom for the scope movements not limited by the speculum with the advantage of prior cervical preparation.  It was certainly at value for operative outpatient hysteroscopy in patients with very high BMI where access was difficult owing to depth.