VaginosCUPy: Using a Modified Menstrual Cup for Hands-Free Vaginoscopic Hysteroscopy. A Feasibility Trial

To evaluate the effectiveness and safety of using a modified menstrual cup for vaginal distention during vaginoscopic hysteroscopy and to assess patient's discomfort and its impact on surgical ergonomics.

Prospective, single-arm feasibility study SETTING: Ambulatory minimally invasive gynecologic surgery units at a public teaching hospital and a private clinic in Caracas, Venezuela.

Sixty-three women aged 16 to 70 years undergoing diagnostic or operative vaginoscopic hysteroscopy between February 1st and November 30th^, 2024.

A modified silicone menstrual cup (stem removed, central aperture created) positioned in the lower third of the vagina to facilitate distention and permit 2-handed instrumentation of the hysteroscopic procedure ("VaginosCUPy" technique).

Successful cup insertion and adequate vaginal distention occurred in 59/63 (93.7%) of the cases. Four postmenopausal women with severe vaginal atrophy could not tolerate the insertion of the CUP. Among successful cases, optimal distention and full visualization were achieved in 59/59 (100%). Cervical stenosis was encountered in 20/63 (31.7%) of the cases; all were overcome and treated using micro-scissors, electrodes, or graspers without complications. Five adolescents with obstructive Müllerian anomalies underwent resection of transverse or oblique vaginal septa with satisfactory immediate results. Patient discomfort was low: 49/63 (77.8%) reported mild pain (VAS 2/10), 10/63 (15.9%) moderate (VAS 3/10), and 4/63 (6.3%) severe. Surgeons rated insertion "easy" in 51/63 (81.0%) and reported improved ergonomics in all successful procedures. No adverse events occurred.

Using a modified menstrual cup enables safe and reliable vaginal distension during vaginoscopic hysteroscopy, allowing for a hands-free approach that improves ergonomics and facilitates the hysteroscopic procedure. Further evaluation is warranted in postmenopausal and virginal patients.