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. 2019 Dec 13:18:eAO4916.
doi: 10.31744/einstein_journal/2020AO4916. eCollection 2020.

Prevalence and intensity of pain during diagnostic hysteroscopy in women attending an infertility clinic: analysis of 489 cases

[Article in English, Portuguese]
Andréa Pegoraro  1 , Marcelo Ettruri Santos  1 , Jean Tetsuo Takamori  1 , Waldemar de Almeida Pereira de Carvalho  1 , Renato de Oliveira  1 , Caio Parente Barbosa  1 , Ângela van Nimwegen  1
Affiliations

Prevalence and intensity of pain during diagnostic hysteroscopy in women attending an infertility clinic: analysis of 489 cases

[Article in English, Portuguese]
Andréa Pegoraro et al. Einstein (Sao Paulo). .

Abstract
in English, Portuguese

Objective: To investigate the prevalence and intensity of pain perception during diagnostic hysteroscopy in women and potential related factors.

Methods: A total of 489 women were investigated at an infertility clinic. Fluid diagnostic hysteroscopy was performed without analgesia or anesthesia by gynecologists with different levels of experience in operative hysteroscopy, using a 2.9mm rigid scope. The Visual Analog Scale was used to score pain intensity after vaginal speculum insertion and after hysteroscopy. Data collected included age, ethnicity, body mass index, history of infertility and endometrial surgery (curettage and/or hysteroscopy), smoking habits, and hysteroscopy diagnosis. Only the state of anxiety was assessed by the State-Trait Anxiety Inventory given to each patient before the procedure.

Results: Hysteroscopy median (25th to 75th) Visual Analog Scale scored 3.3 (3 to 5), and 41.7% of the women referred Visual Analog Scale score ≥4. Median (25th to 75th) State-Trait Anxiety Inventory score was 42 (38 to 45), and 58.3% of the women referred State-Trait Anxiety Inventory score >40. Hysteroscopy Visual Analog Scale score was significantly correlated to surgeon experience and to vaginal speculum insertion but not to State-Trait Anxiety Inventory score, ethnicity or abnormal hysteroscopic findings.

Conclusion: Diagnostic hysteroscopy was mostly perceived as a mild discomfort procedure by most women. Nevertheless, in a considerable number of cases, women perceived hysteroscopy as painful. Pain perception was linked to individual pain threshold and surgeon experience, but not to pre-procedural anxiety state levels, ethnicity or abnormal hysteroscopic findings.

Objetivo: Investigar a prevalência e a intensidade da percepção da dor durante a histeroscopia diagnóstica, bem como os possíveis fatores relacionados.

Métodos: Foram incluídas 489 mulheres submetidas à propedêutica de infertilidade. A histeroscopia diagnóstica foi realizada sem analgesia ou anestesia, por ginecologistas com níveis de experiência diferentes em histeroscopia, usando histeroscópio rígido de 2,9mm. A Escala Visual Analógica foi utilizada para avaliar a intensidade da dor após a inserção do espéculo vaginal e após a histeroscopia. Os dados coletados incluíram idade, etnia, índice de massa corporal, história de infertilidade e cirurgia endometrial (curetagem e/ou histeroscopia), tabagismo e histeroscopia diagnóstica. Avaliou-se apenas o estado de ansiedade pelo Inventário de Ansiedade Traço-Estado de cada paciente antes do procedimento.

Resultados: A mediana (25ºa 75º) de histeroscopia pela Escala Visual Analógica foi 3,3 (3 a 5), e 41,7% das mulheres obtiveram pontuação ≥4. A mediana (25ºa 75º) do Inventário de Ansiedade Traço-Estado foi 42 (38 a 45), e 58,3% das mulheres referiram pontuação >40. A pontuação da Escala Visual Analógica da histeroscopia apresentou correlação estatisticamente significante com a experiência do cirurgião e a inserção do espéculo vaginal, mas não a pontuação do Inventário de Ansiedade Traço-Estado, etnia ou achados histeroscópicos anormais.

Conclusão: A histeroscopia diagnóstica foi percebida pela maioria das mulheres como desconforto leve, mas um número considerável de pacientes classificou o procedimento como doloroso. A percepção da dor esteve ligada ao limiar individual e à experiência do cirurgião, mas não aos níveis de ansiedade pré-procedimento, à etnia e nem aos achados histeroscópicos anormais.

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Conflict of interest statement

Conflict of interest: none.

Figures

Figure 1
Figure 1. Prevalence of pain perception during diagnostic hysteroscopy according to categorized Visual Analog Scale score and surgeon experience
VAS: Visual Analog Scale.
Figura 1
Figura 1. Prevalência da percepção de dor durante histeroscopia diagnóstica, de acordo com a classificação da pontuação na Escala Visual Analógica e a experiência do cirurgião
EVA: Escala Visual Analógica.
See this image and copyright information in PMC

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