Predictors of Procedural Pain in Office Hysteroscopy

BACKGROUND Various strategies have been explored to mitigate office hysteroscopy, including oral or local analgesia, modified cervical dilation techniques, and patient positioning, but there is no consensus on the most effective approach for office hysteroscopy performed for diagnostic purposes. Thus, we aimed to identify independent clinical and other factors associated with increased pain during office hysteroscopy to inform targeted pain reduction strategies. MATERIAL AND METHODS This prospective observational study included 102 women aged 18-70 years who underwent office hysteroscopy at a tertiary center between August and October 2020. Pain intensity was measured using a 10-cm visual analog scale (VAS). Vital signs were monitored before, during, and after the procedure. RESULTS The mean age of participants was 41.62±7.94 years. The mean VAS pain score during hysteroscopy was 4.91±2.97. Patients without a history of vaginal delivery reported significantly higher VAS scores than those with prior vaginal births (P<0.001). Retroverted uterus was associated with greater pain than anteverted or normally positioned uteri (P<0.001). Procedure duration showed a moderate positive correlation with pain (P<0.001), while body mass index (BMI) had a weak negative correlation (P=0.041), and the number of cesarean deliveries had a weak positive correlation with pain intensity (P=0.047). In multivariable analysis, retroverted uterus (P=0.007), longer procedure time (P=0.004), and absence of vaginal delivery (P=0.001) were independently associated with higher pain scores. CONCLUSIONS Retroverted uterine position, nulliparity, and longer procedure duration are independent predictors of increased pain during office hysteroscopy. Awareness of these risk factors allows clinicians to tailor their approach through enhanced pre-procedural counseling, optimized analgesia, and modifications in procedural technique to reduce patient discomfort.