Objective To evaluate the effectiveness of virtual reality as a distraction technique in the management of acute pain and anxiety during outpatient hysteroscopy. Design Parallel group, prospective randomised controlled trial. Setting UK University Hospital. Methods Forty consenting, eligible women were randomised to virtual reality intervention (immersive video content as a distraction method) or standard care during outpatient hysteroscopy from August to October 2018. Main Outcome Measures 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 mixed‐methods randomised control trial. Its wide potential role in ambulatory gynaecologic procedures needs further evaluation.