Journal of minimally invasive gynecology · 2026
VaginosCUPy: Using a Modified Menstrual Cup for Hands-Free Vaginoscopic Hysteroscopy. A Feasibility Trial.
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Fernandez Ramon, Brito Maria, Bruzual Andrea, Rodriguez Silvia, Fernandez Rodrigo, Piekos Patryk, Carugno Jose
Аннотация
OBJECTIVE: 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.
DESIGN: Prospective, single-arm feasibility study SETTING: Ambulatory minimally invasive gynecologic surgery units at a public teaching hospital and a private clinic in Caracas, Venezuela.
PARTICIPANTS: Sixty-three women aged 16 to 70 years undergoing diagnostic or operative vaginoscopic hysteroscopy between February 1st and November 30th, 2024.
INTERVENTIONS: 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).
MEASUREMENTS AND MAIN RESULTS: 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.
CONCLUSION: 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.
DESIGN: Prospective, single-arm feasibility study SETTING: Ambulatory minimally invasive gynecologic surgery units at a public teaching hospital and a private clinic in Caracas, Venezuela.
PARTICIPANTS: Sixty-three women aged 16 to 70 years undergoing diagnostic or operative vaginoscopic hysteroscopy between February 1st and November 30th, 2024.
INTERVENTIONS: 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).
MEASUREMENTS AND MAIN RESULTS: 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.
CONCLUSION: 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.