STATE-OF-THE-ART FLEXIBLE HYSTEROSCOPY FOR OFFICE GYNECOLOGIC EVALUATION

Study Objective. To evaluate office flexible hysteroscopy without anesthesia with regard to pain, inconvenience, and cost. Design. A survey of patients to evaluate the level of pain they experienced during office hysteroscopy, and a comparison of costs for these procedures with those of hospital dilatation and curettage. Setting. Office-based hysteroscopy suite in the outpatient building of a tertiary institution. Patients. Women referred to this institution for gynecologic evaluation between February 1992 and December 1993. Intervention. Diagnostic flexible hysteroscopy without anesthesia, cervical dilatation, or paracervical block. Measurements and Main Results. A total of 417 women (mean age 42 yrs, range 16-84 yrs; 78 postmenopausal) were referred for evaluation during the study period. The most common indication for referral was abnormal uterine bleeding (86%). Hysteroscopy could not be completed in 29 women (7%), primarily because of cervical stenosis. Pain ratings obtained from 387 patients were as follows: easily acceptable discomfort, minimal discomfort during procedure, 133 (34.5%); acceptable discomfort, uncomfortable but easily bearable, 86 (22.2%); tolerable discomfort, equivalent to menstrual cramps and spasms, 106 (27.4%); barely tolerable pain, tolerable for short time only, 48 (12.4%); and intolerable pain, severe enough to stop the procedure before completion, 14 (3.6%). A single adverse event, a postprocedure temperature elevation, was easily treated with oral antibiotics. No pathology was identified in 183 (43%) of the women; 95 (22%) had polyps and 90 (21.5%) had fibroid tumors. The average duration of a procedure was 5 minutes. The charge for office hysteroscopy was $475. Conclusion. Flexible office hysteroscopy without anesthesia was well tolerated by the majority of women. In addition, the procedure is far less expensive and time consuming than when it is performed in an operating room. We believe that it is a safe, well-tolerated, and cost-effective procedure of great diagnostic value.