Call to Action: Pain Management at the Time of Colposcopy: It Should Be Routinely Offered

To advocate for routine discussion and offering of pain-management options to patients undergoing colposcopy with biopsies and/or endocervical sampling.

This commentary reviews published evidence on pain experienced during colposcopy as well as randomized trials and systematic reviews evaluating topical and injected local anesthetics. Current professional guidance regarding pain management for in-office cervical procedures is also reviewed. This commentary further delves into variability in patient pain, effectiveness and limitations of available interventions, and the distinction between routinely administering analgesia and routinely offering patients a choice of pain-management strategies.

Biopsies and endocervical sampling can cause pain with its severity and response varying among patients. Randomized trials demonstrate that topical lidocaine spray and injected local anesthesia can reduce biopsy-associated pain, but findings are heterogeneous and no single regimen has been established as optimal. Systematic reviews similarly support a benefit of local anesthesia for cervical biopsy but also identify limitations in the available evidence. Current guidance recommends discussing and offering pain-management options for in-office gynecologic procedures. Anxiety and nulliparity have been associated with greater biopsy pain, underscoring the difficulty of identifying in advance which patients will experience substantial discomfort.

The absence of one universally effective anesthetic regimen does not justify the routine absence of anesthesia. Patients undergoing colposcopy with biopsies and/or endocervical sampling should be counseled about procedural pain and routinely offered available pain-management options. Offering anesthesia should be a standard component of colposcopic care.