Identifying risk factors for procedural pain in outpatient hysteroscopy: A multivariable analysis.

BACKGROUND

To identify patient-related clinical and anatomical factors associated with increased pain during office hysteroscopy.

METHODS

This retrospective study included women who underwent office hysteroscopy without anesthesia at a tertiary referral center between August and November 2024. Pain intensity was assessed immediately after the procedure using a 10-cm visual analogue scale (VAS). Patients were categorized into no-to-mild pain (VAS < 4) and moderate-to-severe pain (VAS ≥ 4) groups. Clinical characteristics, obstetric history, uterine position, dysmenorrhea severity, and cervical width were analyzed. Univariate and multivariable logistic regression analyses were performed to identify predictors of moderate-to-severe pain.

RESULTS

Among 338 women included in the analysis, aged 15-91 years, 138 (40.8%) experienced moderate-to-severe pain during outpatient hysteroscopy. Moderate-to-severe pain was significantly associated with nulligravidity, absence of prior vaginal delivery, dysmenorrhea, retroflexed uterine position, and cervical width < 4 mm. In multivariable analysis, dysmenorrhea (VAS ≥ 4) (adjusted odds ratio [aOR], 9.42; 95% confidence interval [CI], 4.87 - 18.22, p < 0.001) and cervical width < 4 mm (aOR, 6.51; 95% CI, 2.79 - 15.16, p < 0.001) were identified as independent predictors of moderate-to-severe procedural pain. Absence of prior vaginal delivery and retroflexed uterine position showed borderline associations with increased pain risk.

CONCLUSION

Dysmenorrhea and narrow cervical width are strong independent predictors of moderate-to-severe pain during outpatient hysteroscopy. Recognition of these patient-specific and anatomical factors may facilitate individualized procedural planning, targeted pain management strategies, and improved tolerance of office hysteroscopy.