There has been a growing need for safe and effective lithotomy positioning in the office setting. Since the early 2000s, many procedures such as LEEP, cystoscopy, hysteroscopy, hysteroscopy, anoscopy, endometrial ablation, and hysteroscopic myomectomy and polypectomy have been performed in the office (and others). Through the use of standard OTC medications, oral prescription medications and local anesthesia or mobile anesthesia, excellent pain control has been achieved for patients during in-office procedures.