Pain in diagnostic hysteroscopy: a multivariate analysis after a randomized, controlled trial

Area of Science:

• Gynecology
• Minimally Invasive Surgery
• Pain Management

Background:

• Diagnostic hysteroscopy is a common gynecologic procedure.
• Understanding factors influencing patient pain is crucial for improving the experience.
• Previous studies have explored pain during hysteroscopy with varying results.

Purpose of the Study:

• To identify key variables influencing women's pain perception during diagnostic hysteroscopy.
• To differentiate between factors associated with higher pain scores (VAS>3) and lower pain scores (VAS≤3).

Main Methods:

• A two-phase study involving multivariate analysis following a randomized controlled trial.
• Phase I: 392 patients randomized to carbon dioxide (CO2) or normal saline distension.
• Phase II: Patients categorized by pain (VAS>3 or VAS≤3) for further analysis of influencing factors.

Main Results:

• Normal saline as a distension medium was associated with higher pain scores (VAS>3).
• Longer procedure duration and the presence of cervical synechiae correlated with increased pain.
• Parity demonstrated an inverse correlation with pain, suggesting a protective role.

Conclusions:

• Cervical synechiae, procedure duration, and normal saline use are significant contributors to hysteroscopy pain.
• Parity plays a protective role in mitigating pain during diagnostic hysteroscopy.
• These findings can inform strategies to minimize patient discomfort.