Vaginoscopic approach to outpatient hysteroscopy: a systematic review of the effect on pain
Article first published online: 6 JUL 2010
© 2010 The Authors Journal compilation © RCOG 2010 BJOG An International Journal of Obstetrics and Gynaecology
BJOG: An International Journal of Obstetrics & Gynaecology
Volume 117, Issue 9, page 1164, August 2010
How to Cite
Cooper, N., Smith, P., Khan, K. and Clark, T. (2010), Vaginoscopic approach to outpatient hysteroscopy: a systematic review of the effect on pain. BJOG: An International Journal of Obstetrics & Gynaecology, 117: 1164. doi: 10.1111/j.1471-0528.2010.02613.x
- Issue published online: 6 JUL 2010
- Article first published online: 6 JUL 2010
- Accepted 14 April 2010.
We thank Dr Tsimpanakos and colleagues for their interest in our paper.1,2 We are aware of the H Pipelle as a ‘no-touch’ global endometrial sampling device; however, to our knowledge, its use in routine clinical practice is not widespread. Therefore, our comment that, ‘A vaginal speculum is also required when a global endometrial biopsy is indicated’, is true in the majority of clinics.
We agree that the ethos of ‘no-touch’ hysteroscopy should be extended to include endometrial biopsy, whether this be by utilising hysteroscopically assisted global sampling devices2 or directed biopsies.3 Furthermore, although our systematic review addresses diagnostic outpatient hysteroscopy, we already advocate a vaginoscopic approach to outpatient operative procedures, including hysteroscopic sterilisation4 and bipolar electrosurgery,5 to improve patient comfort and facilitate the manoeuvrability of instruments within the uterine cavity.
Research to explore the accuracy of new ‘no-touch’ sampling devices and the effectiveness of a vaginoscopic approach to hysteroscopic surgery compared with current practices is required.
- 6Handbook of Outpatient Hysteroscopy. A Complete Guide to Diagnosis and Therapy, 1st edn. London: Hodder Education, 2005., .