Outpatient hysteroscopy (standard care)
All procedures were performed in the office setting using a 3.2 mm rigid hysteroscope using normal saline as distension medium. A vaginoscopic technique was utilised unless it failed and dilatation was necessary. Depending on the indications and findings of the hysteroscopy, additional procedures like pipelle biopsies, endometrial biopsies using biopsy forceps, polypectomies, Mirena coil insertions or removals were recorded. Intracervical local anaesthetic infiltration was administered where necessary in the form of rescue analgesia.
Virtual reality during hysteroscopy (intervention)
Immersive and interactive video content was delivered to patients randomised to the virtual reality intervention using an portable, standalone VR headset called Oculus Go with a head mounted display with built in audio drivers. The guided relaxation experience included viewing an 8-minute video called ‘Forest of Serenity’ commissioned by St. Giles Hospice, developed by Holosphere and narrated by Sir David Attenborough27. The immersive video simulated a calming rainforest and a lake setting with animated wildlife, which could be explored by using the headtracker. The video played was one with minimal movement and a familiar voice to achieve maximal desired effect. The video was played for the duration of the procedure and replayed when the procedure exceeded 8 minutes. Patients were allowed to stop viewing the video or remove the headset at their own discretion or in the event of side effects.