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Hum. Reprod. Advance Access published online on July 22, 2006
Human Reproduction, doi:10.1093/humrep/del298
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© The Author 2006. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Received May 22, 2006
Revised June 24, 2006
Accepted June 28, 2006

Article

Vaginoscopic versus traditional office hysteroscopy: a randomized controlled study

M. Guida 1, A. Di Spiezio Sardo 1 *, G. Acunzo 1, S. Sparice 1, S. Bramante 1, R. Piccoli 1, G. Bifulco 1, D. Cirillo 1, M. Pellicano 1, and C. Nappi 1

1 Department of Obstetrics and Gynecology, University of Naples ‘Federico II’, Naples, Italy

* To whom correspondence should be addressed.
A. Di Spiezio Sardo, E-mail: cdispie{at}tin.it


  Abstract

BACKGROUND: A randomized, controlled study was performed to compare vaginoscopic versus traditional (speculum with or without tenaculum) hysteroscopy in terms of pain score and procedure time. METHODS: Three hundred patients were randomized in two groups: Group A, diagnostic hysteroscopy with vaginoscopic approach (150 patients) and Group B, diagnostic hysteroscopy with traditional approach (150 patients). All procedures were performed using a semi-rigid 3.5-mm minihysteroscope with a 0° grade optic. Patients of each group were divided into three subgroups according to their reproductive status: fertile nulliparous (FN), fertile multiparous (FM) and post-menopausal (MEN) women. Women were asked to rate their degree of pain during four phases of the procedure: introduction of hysteroscope (Group A) or speculum (Group B) into the vagina (Phase I) and progression through cervical canal up to internal uterine orifice (IUO) (Phase II), inspection of uterine cavity (Phase III) and performing of endometrial biopsy (Phase IV). A total pain score was calculated for each group. For each patient, the duration of hysteroscopy was recorded from the introduction to the extraction of the scope (Group A) or of the speculum (Group B). RESULTS: Although the median total pain scores were 2 in each group, the 95% confidence interval for vaginoscopic hysteroscopy (1.86-2.01) was significantly (P < 0.05) lower than that for traditional hyster-oscopy (2.10-2.26). Comparison between the corresponding phases of the procedure showed the only significant difference during Phase I of the procedure [Group A: 1 (95% CI 1.0-1.18) versus Group B: 2 (95% CI 2.3-2.8); P < 0.05]. No significant differences in terms of duration of the procedure were observed between the two approaches. CONCLUSIONS: When surgeons using vaginoscopic hysteroscopy with a semi-rigid minihysteroscope were compared with those using traditional approach and the same instrumentation, the operating times and the patients’ pain scores were similar.

Keywords: pain score/procedure time/traditional hysteroscopy/vaginoscopic hysteroscopy introduction.
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[Abstract] [Full Text] [PDF]


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