title: Vaginoscopic approach to outpatient hysteroscopy: a systematic review of the effect on pain.
abstract: 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.
  
  
  METHODS
  MEDLINE, EMBASE, CINAHL and the Cochrane Library were searched for relevant articles. No filters or restrictions were placed on the searches.
  
  
  METHODS
  Randomised controlled trials (RCTs) that assess pain when comparing the vaginoscopic technique versus a traditional hysteroscopy in the outpatient setting.
  
  
  METHODS
  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).
  
  
  RESULTS
  There were six trials (1321 participants) [corrected]. 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, I(2) = 58%). There was no significant difference in the number of failed procedures between groups (P = 0.38).
  
  
  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.
authors.affiliation: University of Birmingham, Birmingham Women's Hospital, Birmingham, UK.
authors.forename: N A M
authors.initials: NA
authors.lastname: Cooper
authors.forename: P
authors.initials: P
authors.lastname: Smith
authors.forename: K S
authors.initials: KS
authors.lastname: Khan
authors.forename: T J
authors.initials: TJ
authors.lastname: Clark
mesh_terms: D000553:Ambulatory Care; D000779:Anesthetics, Local / Q000627:therapeutic use; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D015907:Hysteroscopy / Q000379:methods*; D010146:Pain / Q000517:prevention & control*; D010147:Pain Measurement; D016032:Randomized Controlled Trials as Topic
chemical_list: D000779:Anesthetics, Local