Abstract
This review summarises current understanding and research on the association between anxiety and outpatient hysteroscopy. Women undergoing hysteroscopy suffer from significant levels of anxiety, with repercussions on pain perception, success rates and satisfaction. Using validated tools such as the Spielberger State-Trait Anxiety Index (STAI) or the Hospital Anxiety and Depression Scale (HADS) in the outpatient hysteroscopy setting, average state anxiety scores similar or greater than those measured before more invasive procedures under general anaesthesia have been consistently reported. This clearly suggests a significant gap between our clinical viewpoint of what is “minimally invasive” and patients’ expectations. In spite of its potential role of confounder in studies on pain-reduction interventions, we found that patient anxiety was evaluated in only 9 (13 %) out of a sample of 70 randomised controlled trials on outpatient hysteroscopy published since 1992. Factors such as trait anxiety, age, indication and the efficiency of the clinic can be correlated to state anxiety before hysteroscopy, but more robust data are needed. Promising non-pharmacological interventions to reduce anxiety at hysteroscopy include patient education, communication through traditional or multimedia approaches, interaction and support during the procedure and music listening.
Highlights
During the last decades, enormous progress in technique and instruments has turned hysteroscopy into a common outpatient procedure, with both diagnostic and therapeutic potential, and increasing patient compliance [1, 2]
Anxiety before major procedures can be triggered by the intrinsic invasiveness and risks of surgery and by an understandable fear of the loss of control linked to anaesthesia
As we found in our review of RCTs on pain at hysteroscopy, the visual analog scale (VAS) was the most used tool to verify that anxiety levels between cases and controls were not statistically different (Table 1)
Summary
Enormous progress in technique and instruments has turned hysteroscopy into a common outpatient procedure, with both diagnostic and therapeutic potential, and increasing patient compliance [1, 2]. The assumption of the minimal invasiveness of hysteroscopy is based on facts such as the miniaturisation of scopes, the uncommon need of anaesthesia and the progressive simplification of the technique [3, 4]. This is certainly true, when considering the burden of predecessors such as dilatation and curettage (D&C) or laparotomy. A secondary objective was to determine whether published randomised trials reporting pain at hysteroscopy to date have considered anxiety as a confounding factor
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