Hymen, Godsend or Curse?
Surgical Outpatient Hysteroscopy Using Vaginoscopic Access in Patients with Preserved Hymen

Česká verzia

Authors: Jana Daňková Kučerová ¹; Petr Kovář ²; Tomáš Adamus ³
Authors place of work: Gynprenatal s. r. o., Havířov, vedoucí lékař MUDr. Petr Kovář ¹; Katedra chirurgických oborů (gynekologie) LF Ostravské univerzity v Ostravě, vedoucí katedry doc. MUDr. Pavel Zonča, Ph. D., FRCS ²; Katedra biomedicínských oborů, LF Ostravské univerzity v Ostravě, vedoucí katedry doc. RNDr. Kristian Šafarčík, Ph. D. ³
Published in the journal: Prakt Gyn 2014; 18(1): 71-74
Category: Gynecology and Obstetrics: Review Article

Summary

Introduction:
Virginity in fertile age is not a very frequent condition in Czech Republic and it is not especially valued, loosing it does not discredit women. However, in each gynecologic practice there are groups of woman, who are virgos, examination is limited, diagnosis and treatment of gynecologic problems originated in patologic endometrial changes could be difficult.

Methods:
We use vaginoscopic access standartly in our practice, it means without using gynecological speculum, fixation cervix by forceps, without intrumental dilatation of cervix and also without paracervical block. This method is useful for all patients, especially for women with narrow vagina, nulliparous, postmenopausal women and also for women with preserved hymen.

Results:
In the last four years we have taken care of six patients with preserved hymen by office hysteroscopy (age 17 to 47 years). In two cases it was diagnostical hysteroscopy with biopsy of endometrium, in three cases ablation of endometrial polypus and in the last case ablation of endocervical polypus with biopsy of endometrium. There was no damage of hymen or another complication in all the cases, all the patients tolerated the procedure well and were immediatly released home afterwards.

Conclusion:
Offices hysterocopy using vaginoscopic access is an highly beneficial method in diagnosis and surgery of uterine cavity in patients with preserved hymen, it should be, because of its atraumatic treatment, the method of choice.

Key words:
hymen – hymen-safe hysteroscopy – office hysteroscopy – preserved hymen – vaginoscopic access

Zdroje

1. Moghadami-Tabrizi N, Dabirashrafi H, Mohammad K et al. Surgical vaginoscopy. J Am Assoc Gynecol Laparosc 1994; 1(4): 23.

2. Shui LT, Lee CL, Yen CF et al. Vaginoscopy using hysteroscope for diagnosis of vaginal bleeding during childhood: case report. Changgeng Yi Xue Za Zhi 1999; 22(2): 344–347.

3. Smorgick N, Padua A, Lotan G. Diagnosis and treatment of pediatric vaginal and genital tract abnormalities by small diameter hysteroscope. J Pediatr Surg 2009; 44(8): 1506–1508.

4. Xu D, Xue M, Cheng C et al. Hysteroscopy for the diagnosis and treatment of pathologic changes in the uterine cavity in woman with an intact hymen. J Minim Invasive Gynecol 2006; 13(3): 222–224.

5. Holub Z, Kužel D. Minimálně invazivní operace v gynekologii. Grada Publishing: Praha 2005. ISBN 80–247–0834–5.

6. Kovář P. Hysteroskopie v ambulantním režimu v podmínkách gynekologické ordinace. Česká Gynekol 2010; 75(6): 506–512.

7. Kužel D, Hrazdírová L, Mára M et al. Management a výsledky ambulantní hysteroskopie. Česká Gynekol 2012; 77(4): 308–313.

8. Kovář P, Kučerová J, Szewczyk M et al. Ambulantní hysteroskopická sterilizace Essure – nová technologie permanentní antikoncepce. Prakt Gyn 2013; 17(3): 220–225.

9. Doporučené výkony pro ambulantní hysteroskopii prováděné v gynekologických ambulancích. ČGPS ČLS JEP. Dostupné z WWW: <http://www.laparoskop.cz/doc/Amb_HSK-kody.doc>.

10. Bettochi S, Selvaggi L. A vaginoscopic approach to reduce the pain of office hysteroscopy. J Am Assoc Gynecol Laparosc 1997; 4(2): 255–258.

11. Bettocchi S, Ceci O, Nappi L et al. Operative office hysteroscopy without anesthesia: analysis of 4863 cases performed with mechanical instruments. J Am Assoc Gynecol Laparosc 2004; 11(1): 59–61.

12. Cicinelli E. Diagnostic minihysteroscopy with vaginoscopic approach: rationale and advantages. J Minim Invasive Gynecol 2005; 12(5): 396–400.

13. Küçük T. When virginity does matter: rigid hysteroscopy for diagnostic and operative vaginoscopy – a series of 26 cases. J Minim Invasive Gynecol 2007; 14(5): 651–653.

14. Cheong ML. Minihysteroscopy for examination and management of pathologic lesions of virginal reproductive tracts: can we preserve the hymen intact? Arch Gynecol Obstet 2010; 281(2): 375–376.