Pain perceived during hysteroscopic morcellation by vaginoscopy versus standard technique in an outpatient setting: a randomized controlled trial

Abstract

Objective: To compare pain perceived in women undergoing polyp or fibroid morcellation with a 5.5 mm MyoSure hysteroscope by vaginoscopy vs standard technique, both under sedation in an outpatient setting.

Subjects: Women between the ages 18-52 years; with a clear indication for operative hysteroscopy such as a polyp or type 0/1 fibroid measuring <2 cm, or <4 cm total when more than one lesion was present.

Method: Randomized controlled trial. Patients were randomized into two groups: Group 1 underwent hysteroscopic morcellation using the standard technique, while Group 2 underwent the procedure via vaginoscopy. The primary outcome measured was the participants' self-rated pain perception using the 10-point visual analog scale. The secondary outcomes included duration of the intervention, blood loss, complication at one week follow-up and pregnancy rate at 6 and 12 months. The study was conducted in an outpatient fertility clinic in a tertiary university hospital.

Results: A total of 78 patients were included in the final analysis, with 39 patients per group. Participant baseline characteristics were similar in each group. In an intention-to-treat analysis, the standard technique was found to be significantly less painful than vaginoscopy (mean score 4.0 vs 5.9; difference in means 1.9; p = 0.001). No differences were demonstrated for operative time, postprocedural bleeding, or complication rate. Pregnancy outcomes, including pregnancy rate and pregnancy loss at 6 and 12 months, were not statistically different between the two groups.

Conclusion: Standard technique for polyps or fibroids removal is less painful than vaginoscopy in women under sedation in an outpatient setting using 5.5 mm MyoSure hysteroscope. Therefore, it should be considered the technique of choice.

Keywords: Ambulatory hysteroscopy; Hysteroscopic morcellation; Office hysteroscopy; Operative hysteroscopy; Pain assessment; Pain relief; Vaginoscopy.