Pain Control for Outpatient Colposcopy, Loop Electrode Excision Procedure, Vulvar Biopsy, and Endometrial Biopsy

Outpatient gynecologic biopsies elicit discomfort that negatively impacts patient satisfaction and limits the ability to obtain adequate sampling. We examined relevant studies focusing on colposcopy, loop electrode excision procedure, endometrial biopsies, or vulvar biopsies.

This systematic review conducted a search in PubMed, ClinicalTrials.gov, Embase, and Scopus databases following PRISMA Guidelines. Two reviewers independently extracted data from each study with Covidence software. Exclusion criteria included articles published before 2015, procedures done in inpatient hospital settings, and obstetric procedures. Studies were categorized by procedure type and compared by the primary data point of reduction in pain score during biopsy.

Of 8388 publications screened, 20 colposcopy and LEEP studies, 14 EMB studies, and 3 vulvar biopsy studies were included in the final review. The primary outcome measured across studies was pain score at the time of biopsy.

Lidocaine spray, IUL, PCB, and oral NSAIDs were found to be effective pain control options during EMB. Vulvar biopsy is largely unstudied, but the procedure induces significant changes in VAS scores as compared with patient baselines. For colposcopy and LEEP, local anesthetic with injection of lidocaine is superior to nonpharmacologic interventions such as music. Lidocaine spray remains a better alternative than no pain intervention. Patient preference, while variable, is an important factor to consider when choosing an anesthetic intervention.