Hysteroscopy

Hysteroscopy is used to investigate the inside of the uterine cavity, passing along the natural tracts. A tube with an optical attachment is introduced through the vagina and then the cervix. A special solution is then injected into the cavity so that it can be examined. The investigation is performed by a gynaecologist in primary care consulting rooms or in a hospital.

Hysteroscopy - the process

Hysteroscopy may be used for diagnostic purposes or for a surgical operation. A diagnostic investigation is performed for vaginal bleeding, after assessment of infertility or repeated miscarriages. In surgical hysteroscopy the surgeon can treat fibroids, polyps or mucosal abnormalities. To do this the surgeon uses an electrical scalpel or other surgical instruments, again working through the natural tracts.

The investigation process

No anaesthesia is required for a diagnostic investigation. The patient is positioned on a gynaecology table and the hysteroscopy begins with vaginal disinfection. A speculum is then introduced and forceps are attached to the cervix. Physiological saline is injected continuously through the cervix to swell the uterine cavity. Purpose: to improve visibility. A hysteroscope, 2.5 millimetres to 3 millimetre in diameter is then introduced through the cervix.

The gynaecologist looks at the image on a screen and explores the cervical canal, the uterine cavity, and the fallopian tubes. Superficial biopsies can be taken from the mucosa during the procedure or an intra-uterine device can be removed using a small pair of forceps. General anaesthesia or locoregional anaesthesia is required for a surgical procedure. This is performed in the operating theatre with the patient having fasted. Ambulatory hospitalisation is generally sufficient. The hysteroscope used is usually larger (5 to 9 millimetres in diameter) as it is equipped with surgical instruments.

Possible risks with hysteroscopy

Although very rare, the uterus may be perforated. Uterine infections (endometritis) may also occur after the procedure and require antibiotic treatment.

Sources :

• Gynaecology Congress, the First SEXOGYN Daily Workshops, Marseilles, May 2010;
• Collège national des Gynécologues et obstétriciens français (CNGOF), 18 February 2011.