Hysteroscopic vaginoscopy in the diagnosis of vaginal bleeding

Acomplete gynecological examination of young children and senile patients requires special considerations and techniques. Due to the intact hymenal ring or the very narrow, atrophic vagina, the routinely used instruments, specula, will not allow sufficient visualization. To establish exact diagnosis and apply adequate therapy, proper examination of the vagina is required. For this purpose Huffman-Huber or Cameron-Muller equipment is traditionally used (Fig. 1). A modified Foley catheter was used by Redman, further improving the obtained picture, and the application of a balloon vaginoscope has been described by Terruhn. In spite of all these developments, examinations frequently turn out to be difficult due to insufficient vaginal wall distension and bleeding. Based on our previous experience, we describe a modified vaginoscopy, using hysteroscope and continuous liquid irrigation.