Objective:

To compare the vaginoscopic “no touch” approach to diagnostic outpatient hysteroscopy without anesthesia with traditional diagnostic office hysteroscopy after intracervical injection of prilokaine hydrochloride 2% in terms of pain perception and feasibility.

Material and Methods:

A total of 92 women undergoing diagnostic hysteroscopy were included in the study and were randomized, to one of two treatment groups. Forty-eight women underwent hysteroscopy without speculum, tenaculum, or anesthesia. Forty-four women received intracervical anesthesia with 10 mL of 2% prilocaine hydrochloride solution injected at two sites (3:00 and 9:00 positions) and underwent traditional hysteroscopy. Hysteroscopy was performed using a rigid 3.7-mm hysteroscope and a medium of 0.9% saline. The image was transmitted to a screen visible to the patient. A visual analog scale (VAS) consisting of a 10-cm line was used to assess the intensity of pain experienced during and after the procedure. Satisfaction was assessed by VAS at three different times during the procedure (Stage I: insertion of speculum, tenaculum placement, intracervical block for the traditional hysteroscopy group and insertion of hysteroscope into the vagina, vaginoscopy for the no touch method, Stage II: passage through internal cervical os, Stage III: observation of the uterine cavity and Stage IV: 15 minutes later, after hysteroscopy).

Results:

The mean pain score was significantly lower at Stage I in the no touch group (p<0.01). In five of the patients in no touch group (10.4%), hysteroscopy were unsuccessful because of cervical stenosis. Failure rate was not statistically significant in two groups (p>0.05).

Conclusion:

Patients reported significantly less pain with no touch method at the vaginoscopy compared with patients undergoing the traditional procedure with tenaculum placement and intracervical anesthesia. Both of the methods have had similar pain scores during the rest of the procedures and 15 minutes after the procedure with comparable failure rates. No touch method can therefore be considered as a useful hysteroscopic technique.

Keywords: Outpatient hysteroscopy, pain management