Objective: To evaluate the effectiveness of virtual reality as a distraction technique in the management of acute pain and anxiety during outpatient hysteroscopy. Methods: A parallel group, prospective randomised controlled trial was conducted at a UK University Hospital (August to October 2018) (ClinicalTrials.gov Id: NCT03699280). Forty consenting, eligible women were randomised to virtual reality intervention (immersive video content as a distraction method) or standard care during outpatient hysteroscopy. Pain and anxiety outcomes were measured as a numeric rating score (scale of 0-10). Results: Compared to standard care, women with virtual reality intervention experienced less average pain (score 6.0 vs 3.7, mean difference 2.3, 95% CI 0.61-3.99, p=0.009) and anxiety (score 5.45 vs 3.3, mean difference 2.15, 95% CI 0.38-3.92, p=0.02). Conclusion: Virtual Reality was effective in reducing pain and anxiety during outpatient hysteroscopy in a pilot trial. Its wide potential role in ambulatory gynaecologic procedures needs further evaluation.