title: Office vaginoscopic hysteroscopy in infertile women: effects of gynecologist experience, instrument size, and distention medium on patient discomfort.
abstract: 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.
authors.affiliation: 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
authors.forename: Nicola
authors.initials: N
authors.lastname: Pluchino
authors.forename: Filippo
authors.initials: F
authors.lastname: Ninni
authors.forename: Stefano
authors.initials: S
authors.lastname: Angioni
authors.forename: Paolo
authors.initials: P
authors.lastname: Artini
authors.forename: Viana Gersia
authors.initials: VG
authors.lastname: Araujo
authors.forename: Gabriele
authors.initials: G
authors.lastname: Massimetti
authors.forename: A R
authors.initials: AR
authors.lastname: Genazzani
authors.forename: Vito
authors.initials: V
authors.lastname: Cela
mesh_terms: 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*
chemical_list: D002245:Carbon Dioxide; D012965:Sodium Chloride