Office vaginoscopic hysteroscopy in infertile women: effects of gynecologist experience, instrument size, and distention medium on patient discomfort.
OBJECTIVE
To assess the roles of instrument diameter (5.0- or 3.5-mm external sheath), uterine distention medium (carbon dioxide [CO(2)] or saline solution), and hysteroscopist experience in diagnostic hysteroscopy.


METHODS
Prospective, randomized, multicenter trial (Canadian Task Force classification I).


METHODS
Two university medical centers in Italy.


METHODS
One hundred eighty-four women attending an infertility clinic.


METHODS
Patients were randomly assigned to undergo conventional hysteroscopy (group 1, n = 92) or minihysteroscopy (group 2, n = 92) with CO(2) or saline solution as distention medium. The procedures were performed by hysteroscopists with varying degrees of experience. Patient discomfort was analyzed using the visual analog score. Procedure complications and patient satisfaction rate were also recorded.


RESULTS
Independent of hysteroscopist experience, less pain, fewer complications, and higher satisfaction rates were observed with minihysteroscopy. In addition, procedures in which saline solution was used resulted in less pain and fewer complications than those in which CO(2) was used, but only when performed by inexperienced hysteroscopists.


CONCLUSIONS
Instrument diameter and hysteroscopist experience, but not the distention medium, seem to be the primary variables that affect the perception of discomfort during office hysteroscopy.
Pluchino
Nicola
N
Department of Reproductive Medicine and Child Development, Division of Gynecology and Obstetrics, University of Pisa, Via Roma 35, 56100 Pisa, Italy. nicola.pluchino@med.unipi.it
Ninni
Filippo
F
Angioni
Stefano
S
Artini
Paolo
P
Araujo
Viana Gersia
VG
Massimetti
Gabriele
G
Genazzani
A R
AR
Cela
Vito
V
D000328:Adult; D000556:Ambulatory Surgical Procedures / Q000009:adverse effects / Q000379:methods; D002245:Carbon Dioxide; D005260:Female; D006801:Humans; D020702:Hysteroscopes; D015907:Hysteroscopy / Q000009:adverse effects* / Q000379:methods; D007247:Infertility, Female / Q000175:diagnosis* / Q000601:surgery; D007558:Italy; D010147:Pain Measurement; D017060:Patient Satisfaction; D017699:Pelvic Pain / Q000209:etiology; D011446:Prospective Studies; D012965:Sodium Chloride; D016896:Treatment Outcome; D014599:Uterus / Q000601:surgery; D014621:Vagina / Q000601:surgery*
D002245:Carbon Dioxide; D012965:Sodium Chloride