Background: Outpatient hysteroscopy is a safe, feasible, and optimum procedure for the diagnosis and management of intrauterine pathologies. Objective: To determine the best approach of outpatient hysteroscopy (vaginoscopic vs traditional) in terms of pain, duration of procedure, feasibility, safety, and acceptability. Search Strategy: PubMed, Embase, Google Scholar, and Scopus were searched from January 2000 to October 2021. No filters or restrictions were applied. Selection Criteria: Randomized controlled trials comparing vaginoscopic hysteroscopy with traditional hysteroscopy in an outpatient setting. Data Collection and Analysis: Two authors independently performed a comprehensive literature search and collected and extracted data. The summary effect estimate was determined using both fixed effects and random‐effects models. Results: Seven studies with 2723 patients (vaginoscopic [n = 1378] and traditional hysteroscopy [n = 1345]) were included. Vaginoscopic hysteroscopy was associated with a significant reduction in intraprocedural pain (standardized mean difference, −0.05 [95% confidence interval (CI), −0.33 to −0.23], I2 = 0%), procedural time (standardized mean difference, −0.45 [95% CI, −0.76 to −0.14], I2 = 82%), and fewer side effects (relative risk, 0.37 [95% CI, 0.15–0.91], I2 = 0%). The procedure failure rate was similar in both approaches (relative risk, 0.97 [95% CI, 0.71–1.32], I2 = 43%). Complications were mostly documented with traditional hysteroscopy. Conclusion: Vaginoscopic hysteroscopy reduces the pain and duration compared with traditional hysteroscopy. Synopsis: The vaginoscopic approach to hysteroscopy significantly reduces the pain and duration of the procedure, compared with the traditional speculum‐assisted and cervical instrumentation approach. [ABSTRACT FROM AUTHOR]