Smooth Operator: Nonpharmacologic Approaches for Overcoming Barriers to Office Hysteroscopy.

Importance: Despite the known advantages and incentives for providers and patients, reticence to performing office hysteroscopy remains due to provider inexperience, challenges to adequate pain management, and greater comfort level in the operating room setting. The relatively low utilization across the field of gynecology necessitates a deeper understanding of essential elements of hysteroscopy and the shared skills gained by experience.

Objective: This review serves to aid providers in optimizing periprocedural patient experience and procedural outcomes during in-office hysteroscopy.

Evidence acquisition: A comprehensive literature review was conducted to evaluate nonpharmacologic approaches to pain and anxiety management during in-office hysteroscopy. PubMed, Scopus, and Cochrane Library databases were searched for peer-reviewed articles published in English. Search terms included combinations of "in-office hysteroscopy," "pain management," "anxiety management," "non-pharmacologic," communication," and "office set-up." Additional references were identified from citations within relevant articles. Studies were selected based on relevance, focusing on randomized controlled trials, systematic reviews, meta-analyses, and observational studies. Findings were synthesized to provide a comprehensive overview of current evidence and highlight areas for future research.

Results: Nuanced approaches to pain and anxiety management during in-office hysteroscopy identified include virtual reality, music, hypnosis, and transcutaneous nerve stimulation. Simple strategies such as optimizing office setup while utilizing the newest technological advances and effective communication were identified as ways to alleviate patient discomfort and increase procedure acceptability.

Conclusions and relevance: An understanding of the basic elements of in-office hysteroscopy will benefit patients and providers alike, aiding the transition out of the operating room and into the office setting.