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.