Who should have outpatient hysteroscopy?

Objective To determine criteria by which patients may be selected as suitable for outpatient hysteroscopy. Design Patients undergoing outpatient hysteroscopy filled in visual analogue scales to assess their pain/discomfort during different parts of the procedure. Setting Outpatient hysteroscopy clinic in a district general hospital. Subjects All women referred for outpatient hysteroscopy. Main outcome measure Degree of discomfort/pain as determined from visual analogue scores. Results Age had no effect on acceptability of the procedure. A previous vaginal delivery had an effect on pain/discomfort at insertion of the hysteroscope. Carbon dioxide was less painful than saline, and anxiety before the procedure only had a very small effect. However pain/discomfort at insertion of the speculum had the greatest predictive value with regards to discomfort both during and after the procedure. Conclusions In our study we have demonstrated that those women who found the speculum insertion particularly uncomfortable were more likely to find all parts of the procedure painful. It is this group of women who should be considered for investigation under general anaesthetic. They can be identified at the referral stage removing unnecessary distress for the patient and possible wasted investigation time for the operator.