ABSTRACT
NO-SPECULUM OR ‘VAGINOSCOPIC’ APPROACH The hysteroscope is introduced into the vagina without a speculum or cervical forceps. The labia minora are closed manually and the table tilted downwards slightly to limit the exit of CO2 or normal saline, thus achieving a satisfactory distension of the vagina. The hysteroscope is advanced in order to visualize the cervix and identify the external cervical os, which is traversed, and the hysteroscope slowly introduced into the endocervical canal. Although this approach can lead to unwanted fluid spillage, it is associated with less discomfort by avoiding speculum insertion. Furthermore, the range of external hysteroscopic movement is increased, aiding visualization within the entire uterine cavity. Use of this technique is however, limited because most women undergoing hysteroscopy will require a global endometrial biopsy, which necessitates the use of a speculum. Indications for vaginoscopy are listed in Information Box 4.6.
