Skip to main content

Advertisement

SpringerLink
Log in

Management of anxiety and pain perception in women undergoing office hysteroscopy: a systematic review

  • Review
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

The aim of this review is to provide an overview of the literature about the perception and management of anxiety and pain in women undergoing an office hysteroscopic procedure.

Methods

We performed a systematic literature search in Embase, PubMed/MEDLINE, Cochrane Library and Web of Science for original studies written in English (registered in PROSPERO 2019-CRD42019132341), using the terms ‘hysteroscopy’ AND ‘pain’ AND ‘anxiety’ published up to January 2019. Only original articles (randomized, observational and retrospective studies) about management of anxiety and pain related to the hysteroscopic procedure were considered eligible.

Results

Our literature search produced 84 records. After exclusions, 11 studies including 2222 patients showed the following results: (a) pain experienced during hysteroscopy is negatively affected by preprocedural anxiety; (b) pharmacological interventions seem to be help in reducing pain during hysteroscopy; (c) waiting time before the procedure is a significant factor affecting patients’ anxiety; (d) music during the procedure may be helpful in reducing anxiety.

Conclusions

The utilization of office hysteroscopy is hampered by varying levels of anxiety and pain perceived by women who are candidates for the procedure. For these reasons, it is essential to identify effective pharmacological and non-pharmacological strategies to alleviate these factors. We recommend further studies especially focusing on non-pharmacological interventions to facilitate the dissemination of good clinical practices among hysteroscopists.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Nezhat C (2004) Operative endoscopy will replace almost all open procedures. JSLS 8:101–102

    PubMed  PubMed Central  Google Scholar 

  2. Capmas P, Pourcelot A-G, Giral E et al (2016) Office hysteroscopy: a report of 2402 cases. J Gynecol Obstet Biol Reprod (Paris) 45:445–450. https://doi.org/10.1016/j.jgyn.2016.02.007

    Article  CAS  Google Scholar 

  3. Salazar CA, Isaacson KB (2018) Office operative hysteroscopy: an update. J Minim Invasive Gynecol 25:199–208. https://doi.org/10.1016/j.jmig.2017.08.009

    Article  PubMed  Google Scholar 

  4. Centini G, Troia L, Lazzeri L et al (2016) Modern operative hysteroscopy. Minerva Ginecol 68:126–132

    PubMed  Google Scholar 

  5. Vitale SG, Sapia F, Rapisarda AMC et al (2017) Hysteroscopic morcellation of submucous myomas: a systematic review. Biomed Res Int 2017:6848250. https://doi.org/10.1155/2017/6848250

    Article  PubMed  PubMed Central  Google Scholar 

  6. Laganà AS, Vitale SG, Muscia V et al (2017) Endometrial preparation with Dienogest before hysteroscopic surgery: a systematic review. Arch Gynecol Obstet 295:661–667. https://doi.org/10.1007/s00404-016-4244-1

    Article  PubMed  Google Scholar 

  7. Mairos J, Di Martino P (2016) Office hysteroscopy. an operative gold standard technique and an important contribution to patient safety. Gynecol Surg 13:111–114. https://doi.org/10.1007/s10397-015-0926-0

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Moawad NS, Santamaria E, Johnson M, Shuster J (2014) Cost-effectiveness of office hysteroscopy for abnormal uterine bleeding. JSLS 18(3). https://doi.org/10.4293/JSLS.2014.00393

    Article  PubMed  PubMed Central  Google Scholar 

  9. Siristatidis C, Chrelias C, Salamalekis G, Kassanos D (2010) Office hysteroscopy: current trends and potential applications: a critical review. Arch Gynecol Obstet 282:383–388. https://doi.org/10.1007/s00404-010-1437-x

    Article  PubMed  Google Scholar 

  10. Di Spiezio Sardo A, Minozzi S, Gubbini G, Casadio P (2013) Practical guideline in office hysteroscopy. http://www.endogynaeteam.com/wp-content/uploads/2013/10/Practical-guideline-in-office-hysteroscopy-SEGi.pdf. Accessed 18 Jan 2019

  11. Wortman M, Daggett A, Ball C (2013) Operative hysteroscopy in an office-based surgical setting: review of patient safety and satisfaction in 414 cases. J Minim Invasive Gynecol 20:56–63. https://doi.org/10.1016/j.jmig.2012.08.778

    Article  PubMed  Google Scholar 

  12. Endler M, Bettocchi S, Baranowski W (2011) Office hysteroscopy: a scientific overview. Prz Menopauzalny 15:85

    Google Scholar 

  13. van Kerkvoorde TC, Veersema S, Timmermans A (2012) Long-term complications of office hysteroscopy: analysis of 1028 cases. J Minim Invasive Gynecol 19:494–497. https://doi.org/10.1016/j.jmig.2012.03.003

    Article  PubMed  Google Scholar 

  14. del Valle C, Solano JA, Rodríguez A, Alonso M (2016) Pain management in outpatient hysteroscopy. Gynecol Minim Invasive Ther 5:141–147. https://doi.org/10.1016/j.gmit.2016.08.001

    Article  Google Scholar 

  15. New EP, Sarkar P, Sappenfield E et al (2018) Comparison of patients’ reported pain following office hysteroscopy with and without endometrial biopsy: a prospective study. Minerva Ginecol 70:710–715. https://doi.org/10.23736/S0026-4784.18.04215-6

    Article  PubMed  Google Scholar 

  16. Ahmad G, Attarbashi S, O’Flynn H, Watson AJS (2011) Pain relief in office gynaecology: a systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 155:3–13. https://doi.org/10.1016/j.ejogrb.2010.11.018

    Article  PubMed  Google Scholar 

  17. Jobling P, O’Hara K, Hua S (2014) Female reproductive tract pain: targets, challenges, and outcomes. Front Pharmacol 5:17. https://doi.org/10.3389/fphar.2014.00017

    Article  PubMed  PubMed Central  Google Scholar 

  18. Kaneshiro B, Grimes DA, Lopez LM (2012) Pain management for tubal sterilization by hysteroscopy. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.cd009251.pub2

    Article  PubMed  Google Scholar 

  19. Shamseer L, Moher D, Clarke M et al (2015) Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. BMJ 350:g7647. https://doi.org/10.1136/bmj.g7647

    Article  PubMed  Google Scholar 

  20. Mak N, Reinders IMA, Slockers SA et al (2017) The effect of music in gynaecological office procedures on pain, anxiety and satisfaction: a randomized controlled trial. Gynecol Surg 14:14. https://doi.org/10.1186/s10397-017-1016-2

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Angioli R, De Cicco Nardone C, Plotti F et al (2014) Use of music to reduce anxiety during office hysteroscopy: prospective randomized trial. J Minim Invasive Gynecol 21:454–459. https://doi.org/10.1016/j.jmig.2013.07.020

    Article  PubMed  Google Scholar 

  22. Carta G, Palermo P, Marinangeli F et al (2012) Waiting time and pain during office hysteroscopy. J Minim Invasive Gynecol 19:360–364. https://doi.org/10.1016/j.jmig.2012.01.017

    Article  PubMed  Google Scholar 

  23. Hassan A, Wahba A, Haggag H (2016) Tramadol versus Celecoxib for reducing pain associated with outpatient hysteroscopy: a randomized double-blind placebo-controlled trial. Hum Reprod 31:60–66. https://doi.org/10.1093/humrep/dev291

    Article  CAS  PubMed  Google Scholar 

  24. Kokanali MK, Cavkaytar S, Guzel Aİ et al (2014) Impact of preprocedural anxiety levels on pain perception in patients undergoing office hysteroscopy. J Chin Med Assoc 77:477–481. https://doi.org/10.1016/j.jcma.2014.07.004

    Article  PubMed  Google Scholar 

  25. Ogden J, Heinrich M, Potter C et al (2009) The impact of viewing a hysteroscopy on a screen on the patient’s experience: a randomised trial. BJOG 116:286–292. https://doi.org/10.1111/j.1471-0528.2008.02035.x(discussion 292–293)

    Article  CAS  PubMed  Google Scholar 

  26. Al-Sunaidi M, Tulandi T (2007) A randomized trial comparing local intracervical and combined local and paracervical anesthesia in outpatient hysteroscopy. J Minim Invasive Gynecol 14:153–155. https://doi.org/10.1016/j.jmig.2006.09.007

    Article  PubMed  Google Scholar 

  27. Cicinelli E, Rossi AC, Marinaccio M et al (2007) Predictive factors for pain experienced at office fluid minihysteroscopy. J Minim Invasive Gynecol 14:485–488. https://doi.org/10.1016/j.jmig.2007.03.008

    Article  PubMed  Google Scholar 

  28. Gupta JK, Clark TJ, More S, Pattison H (2004) Patient anxiety and experiences associated with an outpatient “one-stop” “see and treat” hysteroscopy clinic. Surg Endosc 18:1099–1104. https://doi.org/10.1007/s00464-003-9144-3

    Article  CAS  PubMed  Google Scholar 

  29. Mc Gurgan P, O’Donovan P, Jones SE (2001) The effect of operator gender on patient satisfaction: does the “Y” in outpatient hysteroscopy matter? Gynaecol Endosc 10:53–56. https://doi.org/10.1046/j.1365-2508.2001.00388.x

    Article  Google Scholar 

  30. Cutner A, Erian J (1996) Who should have outpatient hysteroscopy? Gynaecol Endosc 5:231–234. https://doi.org/10.1046/j.1365-2508.1996.00441.x

    Article  Google Scholar 

  31. Freeman-Wang T, Walker P, Linehan J et al (2001) Anxiety levels in women attending colposcopy clinics for treatment for cervical intraepithelial neoplasia: a randomised trial of written and video information. BJOG 108:482–484

    CAS  PubMed  Google Scholar 

  32. Bölükbaş N, Erbil N, Kahraman AN (2010) Determination of the anxiety level of women who present for mammography. Asian Pac J Cancer Prev 11:495–498

    PubMed  Google Scholar 

  33. Gustafsson O, Theorell T, Norming U et al (1995) Psychological reactions in men screened for prostate cancer. Br J Urol 75:631–636

    Article  CAS  Google Scholar 

  34. Garcia AL, Green IC (2012) A Practical Guide for Hysteroscopy in the Office (Didactic)

  35. Raju B, Reddy K (2017) Are counseling services necessary for the surgical patients and their family members during hospitalization? J Neurosci Rural Pract 8:114–117. https://doi.org/10.4103/0976-3147.193551

    Article  PubMed  PubMed Central  Google Scholar 

  36. Gambadauro P, Navaratnarajah R, Carli V (2015) Anxiety at outpatient hysteroscopy. Gynecol Surg 12:189–196. https://doi.org/10.1007/s10397-015-0895-3

    Article  PubMed  Google Scholar 

  37. Farzaei MH, Rahimi R, Nikfar S, Abdollahi M (2018) Effect of resveratrol on cognitive and memory performance and mood: a meta-analysis of 225 patients. Pharmacol Res 128:338–344. https://doi.org/10.1016/j.phrs.2017.08.009

    Article  CAS  PubMed  Google Scholar 

  38. Ahmad G, O’Flynn H, Attarbashi S et al (2010) Pain relief for outpatient hysteroscopy. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.cd007710.pub2

    Article  PubMed  PubMed Central  Google Scholar 

  39. Connor M (2015) New technologies and innovations in hysteroscopy. Best Pract Res Clin Obstet Gynaecol 29:951–965. https://doi.org/10.1016/j.bpobgyn.2015.03.012

    Article  PubMed  Google Scholar 

  40. Keyhan S, Munro MG (2014) Office diagnostic and operative hysteroscopy using local anesthesia only: an analysis of patient reported pain and other procedural outcomes. J Minim Invasive Gynecol 21:791–798. https://doi.org/10.1016/j.jmig.2014.03.006

    Article  PubMed  Google Scholar 

  41. Di Spiezio Sardo A, Calagna G, Di Carlo C (2015) Tips and tricks in office hysteroscopy. Gynecol Minim Invasive Ther 4:3–7. https://doi.org/10.1016/j.gmit.2014.12.004

    Article  Google Scholar 

  42. Sagiv R, Sadan O, Boaz M et al (2006) A new approach to office hysteroscopy compared with traditional hysteroscopy: a randomized controlled trial. Obstet Gynecol 108:387–392. https://doi.org/10.1097/01.AOG.0000227750.93984.06

    Article  PubMed  Google Scholar 

  43. Sharma M, Taylor A, di Spiezio Sardo A et al (2005) Outpatient hysteroscopy: traditional versus the “no-touch” technique. BJOG 112:963–967. https://doi.org/10.1111/j.1471-0528.2005.00425.x

    Article  CAS  PubMed  Google Scholar 

  44. Tsimpanakos I, Gkoutzioulis A, Moustafa M et al (2010) Vaginoscopic approach to outpatient hysteroscopy: a systematic review of the effect on pain. BJOG 117:1163–1164. https://doi.org/10.1111/j.1471-0528.2010.02615.x(author reply 1164)

    Article  CAS  PubMed  Google Scholar 

  45. Bettocchi S, Selvaggi L (1997) A vaginoscopic approach to reduce the pain of office hysteroscopy. J Am Assoc Gynecol Laparosc 4:255–258. https://doi.org/10.1016/S1074-3804(97)80019-9

    Article  CAS  PubMed  Google Scholar 

  46. Vitale SG, Bruni S, Chiofalo B, Riemma G, Lasmar RB (2020) Updates in office hysteroscopy: a practical decalogue to perform a correct procedure. Updates Surg. https://doi.org/10.1007/s13304-020-00713-w

    Article  PubMed  Google Scholar 

  47. Vitale SG (2019) The biopsy snake grasper sec. VITALE: a new tool for office hysteroscopy. J Minim Invasive Gynecol. https://doi.org/10.1016/j.jmig.2019.12.014

    Article  PubMed  Google Scholar 

  48. Michelotti A, Farella M, Tedesco A et al (2000) Changes in pressure-pain thresholds of the jaw muscles during a natural stressful condition in a group of symptom-free subjects. J Orofac Pain 14:279–285

    CAS  PubMed  Google Scholar 

  49. Zachariae R, Melchiorsen H, Frøbert O et al (2001) Experimental pain and psychologic status of patients with chest pain with normal coronary arteries or ischemic heart disease. Am Heart J 142:63–71. https://doi.org/10.1067/mhj.2001.115794

    Article  CAS  PubMed  Google Scholar 

  50. Garron DC, Leavitt F (1983) Psychological and social correlates of the back pain classification scale. J Pers Assess 47:60–65. https://doi.org/10.1207/s15327752jpa4701_7

    Article  CAS  PubMed  Google Scholar 

  51. Tang J, Gibson SJ (2005) A psychophysical evaluation of the relationship between trait anxiety, pain perception, and induced state anxiety. J Pain 6:612–619. https://doi.org/10.1016/j.jpain.2005.03.009

    Article  PubMed  Google Scholar 

  52. Reiss S (1997) Trait anxiety: it’s not what you think it is. J Anxiety Disord 11:201–214

    Article  CAS  Google Scholar 

  53. Harkness K, Morrow L, Smith K et al (2003) The effect of early education on patient anxiety while waiting for elective cardiac catheterization. Eur J Cardiovasc Nurs 2:113–121. https://doi.org/10.1016/S1474-5151(03)00027-6

    Article  PubMed  Google Scholar 

  54. De Angelis C, Santoro G, Re ME, Nofroni I (2003) Office hysteroscopy and compliance: mini-hysteroscopy versus traditional hysteroscopy in a randomized trial. Hum Reprod 18:2441–2445

    Article  Google Scholar 

  55. Bettocchi S, Nappi L, Ceci O, Selvaggi L (2003) What does “diagnostic hysteroscopy” mean today? The role of the new techniques. Curr Opin Obstet Gynecol 15:303–308. https://doi.org/10.1097/01.gco.0000084241.09900.c8

    Article  PubMed  Google Scholar 

  56. Kozman E, Collins P, Howard A et al (2001) The effect of an intrauterine application of two percent lignocaine gel on pain perception during Vabra endometrial sampling: a randomised double-blind, placebo-controlled trial. BJOG 108:87–90

    CAS  PubMed  Google Scholar 

  57. Amer-Cuenca JJ, Marín-Buck A, Vitale SG et al (2020) Non-pharmacological pain control in outpatient hysteroscopies. Minim Invasive Ther Allied Technol 29:10–19. https://doi.org/10.1080/13645706.2019.1576054

    Article  PubMed  Google Scholar 

  58. Keogh SC, Fry K, Mbugua E et al (2014) Vocal local versus pharmacological treatments for pain management in tubal ligation procedures in rural Kenya: a non-inferiority trial. BMC Womens Health 14:21. https://doi.org/10.1186/1472-6874-14-21

    Article  PubMed  PubMed Central  Google Scholar 

  59. Horn S, Munafo M (1997) Pain: theory, research and intervention. Open University Press, Buckingham

    Google Scholar 

Download references

Funding

The work was not supported by any fund/grant.

Author information

Authors and Affiliations

  1. Obstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy

    Salvatore Giovanni Vitale, Salvatore Caruso, Ferdinando Antonio Gulino & Antonio Cianci

  2. Second Department of Obstetrics and Gynecology, The Center of Postgraduate Medical Education, Warsaw, Poland

    Michal Ciebiera

  3. Faculty of Medicine, Institute of Obstetrics and Gynaecology, University of Debrecen, Debrecen, Hungary

    Péter Török

  4. MARGen Clinic, Granada, Spain

    Jan Tesarik

  5. Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada

    George Angelos Vilos

  6. Department of Obstetrics and Gynecology, Advocate Lutheran General Hospital, Park Ridge, IL, USA

    Aarathi Cholkeri-Singh

  7. Department of Reproductive Medicine, Christian Medical College, Vellore, India

    Mohan Shashikant Kamath

Authors
  1. Salvatore Giovanni Vitale
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Salvatore Caruso
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michal Ciebiera
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Péter Török
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jan Tesarik
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. George Angelos Vilos
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Aarathi Cholkeri-Singh
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ferdinando Antonio Gulino
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Mohan Shashikant Kamath
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Antonio Cianci
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

SGV: project development and manuscript writing; SC: manuscript writing; MC: manuscript writing; PT: data collection and management; JT: manuscript editing; GAV: manuscript editing; AC-S: manuscript editing, FAG: data collection and management; MSK: manuscript editing; AC: project supervision and final approval.

Corresponding author

Correspondence to Salvatore Giovanni Vitale.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent is not required for this type of study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Vitale, S.G., Caruso, S., Ciebiera, M. et al. Management of anxiety and pain perception in women undergoing office hysteroscopy: a systematic review. Arch Gynecol Obstet 301, 885–894 (2020). https://doi.org/10.1007/s00404-020-05460-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-020-05460-2

Keywords

Search

Navigation