Key content Routine diagnostic hysteroscopy under general anaesthesia is an anachronism. Evidence‐based RCOG guidance should be followed to ensure best practice in outpatient hysteroscopy. The role of hysteroscopy in the diagnostic work‐up of abnormal bleeding and reproduction remains unclear and further research is required to elucidate where it can be used most cost‐effectively. Learning objectives A ‘no touch’ vaginoscopic technique should be employed routinely as this approach reduces pain during diagnostic rigid outpatient hysteroscopy and facilitates operative procedures by improving manipulation of miniature endoscopic equipment. A contemporary outpatient hysteroscopy service should be able to provide surgical treatments for uterine polyps, small fibroids, lost coils, minor uterine anomalies, menstrual disorders and permanent contraception. Ethical issues Can we justify subjecting women, especially those with significant medical co‐morbidities, to the risks and inconvenience of general anaesthesia for hysteroscopic procedures?