Abstract
ABSTRACTObjective To investigate the prevalence and intensity of pain perception during diagnostic hysteroscopy in women and potential related factors.Methods A total of 489 women were investigated at an infertility clinic. Fluid diagnostic hysteroscopy was performed without analgesia or anesthesia by gynecologists with different levels of experience in operative hysteroscopy, using a 2.9mm rigid scope. The Visual Analog Scale was used to score pain intensity after vaginal speculum insertion and after hysteroscopy. Data collected included age, ethnicity, body mass index, history of infertility and endometrial surgery (curettage and/or hysteroscopy), smoking habits, and hysteroscopy diagnosis. Only the state of anxiety was assessed by the State-Trait Anxiety Inventory given to each patient before the procedure.Results Hysteroscopy median (25th to 75th) Visual Analog Scale scored 3.3 (3 to 5), and 41.7% of the women referred Visual Analog Scale score ≥4. Median (25th to 75th) State-Trait Anxiety Inventory score was 42 (38 to 45), and 58.3% of the women referred State-Trait Anxiety Inventory score >40. Hysteroscopy Visual Analog Scale score was significantly correlated to surgeon experience and to vaginal speculum insertion but not to State-Trait Anxiety Inventory score, ethnicity or abnormal hysteroscopic findings.Conclusion Diagnostic hysteroscopy was mostly perceived as a mild discomfort procedure by most women. Nevertheless, in a considerable number of cases, women perceived hysteroscopy as painful. Pain perception was linked to individual pain threshold and surgeon experience, but not to pre-procedural anxiety state levels, ethnicity or abnormal hysteroscopic findings.
Highlights
Hysteroscopy represents the gold standard for the evaluation of the uterine cavity and adequate endometrial sampling due to its minimal invasiveness and high diagnostic success rate.[1,2] hysteroscopy remains painful, and approximately 30% of women referring considerable pain.[3]. Potential factors linked to pain perception during this procedure include scope diameter,(3) medical experience, anxiety, and reproductive status.[4]
These patients were initially included in the statistics, but we decided to exclude them for three reasons: [1] no hysteroscopy diagnosis was obtained since all patients asked to stop the procedure before uterine cavity being reached; [2] their pain threshold (VAS) may be comparable to the women that reported severe pain (VAS 8 to 10), but their pain tolerance was different; and [3] no changes were observed in the statistics after their withdrawal
The majority of the women had primary infertility, self-reported as white skin, non-smoker, overweight BMI, no history of endometrial surgery, and diagnostic hysteroscopy was performed in the proliferative phase
Summary
Hysteroscopy represents the gold standard for the evaluation of the uterine cavity and adequate endometrial sampling due to its minimal invasiveness and high diagnostic success rate.[1,2] hysteroscopy remains painful, and approximately 30% of women referring considerable pain.[3]. The use of mini-hysteroscopes (outer sheet diameter from 3 to 3.7mm) reduced significantly pain perception levels when compared to conventional 5mm devices. This technique has a less traumatic passage through the cervical canal and the internal part, leading to a less painful and better-tolerated examination. For the evaluation of pain intensity, a method commonly used is the Visual Analog Scale (VAS). This tool is easy to be used, the results are reproducible, and it can be applied in a variety of practical settings.[8]
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