• P P Smith, S Kolhe, S O'Connor, and T J Clark.
• Institute of Metabolism and Systems Research, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK.
• BJOG. 2019 Jun 1; 126 (7): 891-899.

ObjectiveTo evaluate whether vaginoscopy or standard hysteroscopy was more successful in the outpatient setting.DesignRandomised controlled multicentre trial.SettingOutpatient hysteroscopy clinics at two UK hospitals.Population1597 women aged 16 or older undergoing an outpatient hysteroscopy.MethodsWomen were allocated to vaginoscopy or standard hysteroscopy using third party randomisation stratified by menopausal status with no blinding of participants or clinicians.Main Outcome MeasuresThe primary outcome was 'success', a composite endpoint defined as: a complete procedure, no complications, a level of pain acceptable to the patient, and no sign of genitourinary tract infection 2 weeks after the procedure.ResultsVaginoscopy was significantly more successful than standard hysteroscopy [647/726 (89%) versus 621/734 (85%), respectively; relative risk (RR) 1.05, 95% CI 1.01-1.10; P = 0.01]. The median time taken to complete vaginoscopy was 2 minutes compared with 3 minutes for standard hysteroscopy (P < 0.001). The mean pain score was 42.7 for vaginoscopy, which was significantly less than standard hysteroscopy 46.4 (P = 0.02). Operative complications occurred in five women receiving vaginoscopy and 19 women receiving standard hysteroscopy (RR 0.26, 95% CI 0.10-0.69).ConclusionsVaginoscopy is quicker to perform, less painful, and more successful than standard hysteroscopy and therefore should be considered the technique of choice for outpatient hysteroscopy.Tweetable AbstractVaginoscopy is quicker to perform, less painful, and more successful than standard hysteroscopy.© 2019 Royal College of Obstetricians and Gynaecologists.

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