Hysteroscopy is an effective, minimally invasive procedure for the diagnosis and treatment of intrauterine pathology. Selection of a distending medium requires consideration of the advantages, disadvantages, and risks associated with various media as well as their compatibility with electrosurgical or laser energy. Preoperative discussions with patients should address risks and benefits of the procedure, comorbidities, analgesia or anesthesia, and possible preoperative cervical dilation. Pregnancy, genital tract infection, and uterine carcinoma are contraindications to hysteroscopy. Possible complications include hemorrhage, fluid overload, perforation, visceral injury, infection, and embolization.