title: Effect of pre-procedural state-trait anxiety on pain perception and discomfort in women undergoing colposcopy for cervical cytological abnormalities.
abstract: BACKGROUND
  Colposcopy is the gold standard procedure for evaluating cervical cytological abnormalities. Although it is essentially a minimally invasive intervention, referral for colposcopy may cause significant distress on patients. In this study, we aimed to determine if pre-procedural anxiety levels have a significant association with procedure related pain and discomfort in women undergoing colposcopy for evaluation of abnormal cervical cytology. We also assessed the impact of various clinical factors on anxiety, pain and discomfort in these patients.
  
  
  METHODS
  This prospective study was performed at the Gynecologic Oncology Department of Zekai Tahir Burak Women's Health Education and Research Hospital in Ankara, Turkey between January and June 2013. After taking informed consent, State-Trait Anxiety Inventory (STAI) form and a 14-item questionnaire were filled for women who were admitted to our outpatient colposcopy unit for evaluation of abnormal cervical cytology. STAI scores were calculated for each participant. Immediately after the procedure, visual analog scale (VAS) scores for procedure-related pain and discomfort were obtained. Associations between STAI and VAS scores were investigated using correlation analyses. The effect of various contributing factors on anxiety, pain and discomfort were evaluated with linear regression analysis. The p values less than 0.05 were considered statistically significant.
  
  
  RESULTS
  A total of 222 women met the inclusion criteria within the study period. Mean patient age was 38.5±9.6. Median state and trait anxiety scores were 47 and 46, respectively. Median VAS scores for pain and discomfort were 4 for both variables. State anxiety had a significant correlation with procedure related discomfort (p=0.02). Colposcopy related pain VAS scores were significantly affected by state anxiety level, marital status and prior gynecological examination (p<0.05). Colposcopy related discomfort VAS scores were significantly affected by state anxiety level, marital status, prior gynecological examination and educational status.
  
  
  CONCLUSIONS
  Additional measures should be implemented in women that carry higher risk for experiencing pain and discomfort. Social, cultural and lifestyle issues may also affect women's experiences during colposcopy, therefore further studies are needed to define specific determining factors in various populations.
authors.affiliation: Department of Gynecologic Oncology, Zekai Tahir Burak Women's Health Education and Research Hospital, Altindag, Ankara, Turkey. eralpbaser@gmail.com
authors.forename: Eralp
authors.initials: E
authors.lastname: Baser
authors.forename: Cihan
authors.initials: C
authors.lastname: Togrul
authors.forename: Emre
authors.initials: E
authors.lastname: Ozgu
authors.forename: Alev
authors.initials: A
authors.lastname: Esercan
authors.forename: Mete
authors.initials: M
authors.lastname: Caglar
authors.forename: Tayfun
authors.initials: T
authors.lastname: Gungor
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D000368:Aged; D001007:Anxiety / Q000209:etiology / Q000517:prevention & control*; D003127:Colposcopy / Q000009:adverse effects / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D058748:Pain Perception; D011379:Prognosis; D011446:Prospective Studies; D013315:Stress, Psychological / Q000209:etiology / Q000517:prevention & control*; D011795:Surveys and Questionnaires; D002583:Uterine Cervical Neoplasms / Q000150:complications / Q000175:diagnosis / Q000523:psychology*; D055815:Young Adult