title: Pain in diagnostic hysteroscopy: a multivariate analysis after a randomized, controlled trial.
abstract: OBJECTIVE
  To study which variables are able to influence women's experience of pain during diagnostic hysteroscopy.
  
  
  METHODS
  Multivariate analysis (phase II) after a randomized, controlled trial (phase I).
  
  
  METHODS
  Endoscopic gynecologic center.
  
  
  METHODS
  In phase I, 392 patients were analyzed. Group A: 197 women with carbon dioxide (CO2); group B: 195 women with normal saline. In phase II, 392 patients were assigned to two different groups according to their pain experience as measured by a visual analogue scale (VAS): group VAS>3 (170 patients); group VAS≤3 (222 patients).
  
  
  METHODS
  Free-anesthesia diagnostic hysteroscopy performed using CO2 or normal saline as distension media.
  
  
  METHODS
  Procedure time, VAS score, image quality, and side effects during and after diagnostic hysteroscopy.
  
  
  RESULTS
  In phase I the median pain score in group A was 2, whereas in group B it was 3. In phase II the duration of the procedure, nulliparity, and the use of normal saline were significantly correlated with VAS>3. A higher presence of cervical synechiae was observed in the group VAS>3. The multivariate analysis revealed an inverse correlation between parity and a VAS>3, whereas the use of normal saline, the presence of synechiae in the cervical canal, and the duration of the hysteroscopy were all directly correlated to a VAS score>3.
  
  
  CONCLUSIONS
  Pain in hysteroscopy is significantly related to the presence of cervical synechiae, to the duration of the procedure, and to the use of normal saline; conversely, parity seems to have a protective role.
  
  
  BACKGROUND
  NCT01873391.
authors.affiliation: "Arbor Vitae" Center, Clinica Nuova Villa Claudia, Rome, Italy.
authors.forename: Ivan
authors.initials: I
authors.lastname: Mazzon
authors.affiliation: Department of Obstetrics and Gynecology, University of Perugia, Perugia, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Favilli
authors.affiliation: "Arbor Vitae" Center, Clinica Nuova Villa Claudia, Rome, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Grasso
authors.affiliation: "Arbor Vitae" Center, Clinica Nuova Villa Claudia, Rome, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Horvath
authors.affiliation: Department of Obstetrics and Gynecology, University of Perugia, Perugia, Italy.
authors.forename: Vittorio
authors.initials: V
authors.lastname: Bini
authors.affiliation: Department of Obstetrics and Gynecology, University of Perugia, Perugia, Italy.
authors.forename: Gian Carlo
authors.initials: GC
authors.lastname: Di Renzo
authors.affiliation: Department of Obstetrics and Gynecology, University of Perugia, Perugia, Italy. Electronic address: sandro.gerli@unipg.it.
authors.forename: Sandro
authors.initials: S
authors.lastname: Gerli
mesh_terms: D000328:Adult; D003287:Contrast Media / Q000009:adverse effects; D005260:Female; D006175:Gynatresia / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D015907:Hysteroscopy / Q000009:adverse effects*; D007327:Insufflation / Q000009:adverse effects*; D007558:Italy; D015999:Multivariate Analysis; D010146:Pain / Q000175:diagnosis / Q000209:etiology*; D012307:Risk Factors; D012965:Sodium Chloride / Q000009:adverse effects*
chemical_list: D003287:Contrast Media; D012965:Sodium Chloride
keywords: Diagnostic hysteroscopy; carbon dioxide; distension media; pain; saline solution