Pain determinants during office hysteroscopy: Insights from clinical and procedural factors: A nine-year prospective...

Hysteroscopy is regarded as the gold standard for current gynecological assessment. Many patients tolerate hysteroscopy without anesthesia but a small proportion experience significant pain that leads to procedure discontinuation. Thus, our aim was to identify patients and procedure-related parameters that contribute to severe pain perception. We developed a predictive model to discriminate between candidates at risk for severe pain to enhance patient acceptance, comfort, and hysteroscopic outcome.

This prospective cohort study enrolled 788 cases referred to a hysteroscopic clinic for diverse causes. For each patient, we recorded demographic, reproductive, and procedure-related variables, including pain assessed by using a visual analog scale.

Severe pain was reported in 10.4 % (P < 0.0001) of patients. Mean patient age was 35 ± 9.35 years and the mean procedure time was 5.05 ± 2.98 min, and both had no effect on the pain score. The strongest pain predictors according to multivariate logistic regression were prior history of curettage (odds ratio (OR) = 3.72; 95 % confidence interval (CI) = 1.00-12.7; P = 0.04) and primary infertility (OR = 2.59; 95 % CI = 1.45-4.6; P = 0.001). Endometrial biopsy, ostia abnormalities, and cervical stenosis increased the pain odds with OR values of 1.50, 1.48, and 1.21, respectively.

High probabilities of pain perception were reported among patients with a history of dilatation and curettage, primary infertility, endometrial biopsy, cervical stenosis, and ostia abnormality. Those populations are considered to be at heightened risk of severe pain perception during hysteroscopy. Discriminating those groups can facilitate pre-procedure counseling and alternative pain therapy may be offered to improve the standard of care and overall hysteroscopic results.