Acceptability and pain of outpatient hysteroscopy

Study Objective. To investigate the pain and acceptability of diagnostic hysteroscopy performed without local anesthesia. Design. Prospective, observational study (Canadian Task Force classification II-2). Setting. University-associated department of obstetrics and gynecology. Patients. The 1144 consecutive women who underwent diagnostic hysteroscopy. Interventions. Diagnostic hysteroscopy and endometrial biopsy as indicated. Measurements and Main Results. Patients were asked to rate the pain experienced on a 10-cm visual analog scale and to state if they were willing to repeat the procedure. The mean pain score was 4.7 +/- 2.5; 398 patients (34.8%) experienced severe pain. No risk factors for painful hysteroscopy were found, although abnormality of the cervical canal was associated with high pain scores. Acceptance of the procedure was high, 83.0% (950 women). Conclusion. Diagnostic hysteroscopy is a painful procedure even when performed with atraumatic technique by experienced surgeons. Most women, however, stated they were willing to have a second procedure under the same conditions.