Predictors of outpatient hysteroscopy pain: A role for retrospective cervical screening pain estimates? A service evaluation
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Outpatient hysteroscopy(OPH) is a key diagnostic approach in gynaecology, valued for its cost efficiency and avoidance of general anaesthesia. However, severe pain affects 15–34.8% of patients, compromising procedure success, as well as patient well-being and satisfaction. Despite this, predictors of pain remain underexplored. This service evaluation examined data from 804 patients undergoing OPH. Pre-procedure variables, including prior procedural pain (e.g. cervical screening), childbirth history and clinical details, were assessed using stepwise logistic regression to predict patient-reported pain levels.
Retrospective pain ratings from previous cervical screenings emerged as the strongest predictors of OPH pain. Patients who recalled moderate or severe pain during cervical screening were significantly more likely to report severe pain during OPH(p < 0.001). Multiparity was linked to reduced pain perception, although interestingly, this doesn’t appear to be associated with vaginal vs Caesarean delivery. Diagnostic hysteroscopy is likely to be more painful than polypectomy which is likely due to the inclusion of endometrial biopsy when undertaking a diagnosis. Similarly, IUD removal, which requires no biopsy, is less likely to elicit pain than diagnostic investigation of pre or post-menopausal bleeding, which does.
These findings highlight the potential of pre-procedural pain history, particularly from cervical screening, as an easily applied predictor for OPH pain. Overall, this approach could be valuable in identifying patients at risk of a painful procedure. Ultimately, this approach could be optimised to facilitate predictive stratification of patients to sedation, which could enhance success rates in OPH and protect patient well-being. This study introduces a range of presurgical risk factors, including cervical screening pain history as a novel, domain-specific predictor. This offers an opportunity to personalize patient care, reduce the burden of severe pain, and improve procedural outcomes in OPH.
Plain Language Summary
Outpatient hysteroscopy (OPH) is a widely used gynaecological procedure for examining the uterine cavity. As an outpatient procedure, OPH is cost-effective and aligns with healthcare policies aimed at reducing hospital admissions. However, it is frequently associated with significant pain, with up to 85% of patients reporting pain during the procedure. Identifying patients at risk of severe pain is critical to improving the patient experience and reducing procedure failure rates.
This service evaluation analysed data from 804 women undergoing OPH at a UK hospital to identify factors that predict pain levels. Analysis revealed that women who experienced prior painful cervical screening were more likely to report higher pain during OPH. Other predictors included the type of procedure or the patient’s childbirth history. Interestingly, women who had given birth experienced less pain than those who had not.
These findings may support the use of simple pre-procedure questionnaire to identify risk factors, such as history of painful cervical screening or child-birth history, to identify patients at risk of severe pain during OPH. While more research is needed to confirm these results, this study highlights the importance of understanding individual risk factors to make OPH safer, less painful and more tolerable for all women.
