Factors affecting pain experienced during office hysteroscopy

Study objective: To evaluate the effect of parity, menopausal status, menstrual cycle phase, cervical or uterine pathology and duration of procedure on pain experienced during office hysteroscopy. Design: Cohort study (Canadian Task Force classification II-2). Setting: University hospital. Patients: Two hundred and fifty-four women. Intervention: Office hysteroscopy without anesthesia. Methodology: Pain intensity was assessed at the end of procedure using visual analog scale from zero (no pain) to ten (intolerable pain). Results: Eighty-six patients (33.86%) reported no pain or mild discomfort (0–3 pain score), 118 patients (46.46%) reported moderate pain (4–7 pain score), 44 patients (17.32%) experienced severe pain (8–9 pain score) and 6 patients (2.36%) experienced intolerable pain (10 pain score) necessitating stoppage of the procedure. Bivariate analysis revealed that nulliparous patients had a higher risk of developing severe or intolerable pain compared with non-nulliparous patients (26.67% vs. 11.76%, P value = 0.003). Moreover, severe or intolerable pain was reported more frequently in patients with cervical pathology and duration of procedure more than 2 min (39.58% vs. 15.05%, P value = 0.0001 and 25.22% vs. 15.11%, P value = 0.044 respectively). Multivariate analysis revealed that nulliparity, cervical pathology and duration of procedure more than 2 min were strongly associated with severe or intolerable pain (8–10 pain score). Conclusion: Nulliparity, cervical pathology and duration of procedure more than 2 min seem to be the main factors associated with severe or intolerable pain during office hysteroscopy