ABSTRACT
The internal cervical os is generally the narrowest portion of the cervical canal and this, combined with its more fibrous composition, can obstruct entry into the uterine cavity when hysteroscopic sheaths 4 mm diameter are employed. A slight pause at this point allows the inflowing medium time to further distend the uterine isthmus and assist painless entry into the cavity. The hysteroscope is then advanced under direct vision, and care taken when the uterine cavity is entered to steer the hysteroscope correctly, in keeping with the axis of the uterine body, thereby avoiding touching the uterine wall. If a 30° hysteroscope is used, then the beginner may experience some difficulty, as the telescope will not be advancing in the direction that appears on the monitor. In addition, rotation of a fore-oblique
• Postmenopausal women (hypo-oestrogenic/senile changes) • Nulliparity • Previous cervical biopsy • Previous uterine surgery (ablation, D&C and Caesarean section) • Uterine fibroids (deviation and/or compression) • Previous uterine infection (adhesions) • Treatment with gonadotrophic releasing hormone (hypo-oestrogenic changes)
• Cervical countertraction. A single-toothed vulsellum or tenaculum may be applied to the anterior cervical lip. A ‘pin-point’ cervix or a cervix flush with vault (following cone biopsy) can then usually be overcome.
