title: Pain during diagnostic hysteroscopy: what is the role of the cervical canal? A pilot study.
abstract: OBJECTIVE
  To evaluate whether a correlation exists between the pain perceived during diagnostic anesthesia-free hysteroscopy and the characteristics of the cervical canal.
  
  
  METHODS
  Prospective observational pilot study of 255 women undergoing diagnostic hysteroscopy. Data analysis included characteristics of the patient and the cervical canal, and the pain experience during the procedure, assessed by visual analog score (VAS). A multiple logistic regression was then carried out in order to exclude confounding factors.
  
  
  RESULTS
  The degree of pain during hysteroscopy was equal to a median VAS score of 2 (range 0-10). Bivariate analysis between patients with VAS>3 and patients with VAS≤3 demonstrated a significant correlation between pain and the presence of synechiae in the cervical canal (P=0.022), the patient's age (P=0.003) and parity (P=0.001). Multivariate analysis revealed that the presence of cervical synechiae (P=0.0001) [OR=4.99 (95% CI 2.13-11.70)] and parity (P=0.014) [OR=0.42 (95% CI 0.21-0.83)] were significantly correlated with pain. There was no significant correlation with the different angles of the cervical canal.
  
  
  CONCLUSIONS
  Cervical synechiae appear as a major factor influencing pain during hysteroscopy. While parity acts as a protective factor, the angle of the cervical canal does not seem to play an important role for pain during diagnostic hysteroscopy.
authors.affiliation: "Arbor Vitae" Centre, Clinica Nuova Villa Claudia, 00191 Rome, Italy.
authors.forename: Ivan
authors.initials: I
authors.lastname: Mazzon
authors.affiliation: Department of Obstetrics and Gynecology, University of Perugia, S.M. della Misericordia Hospital, 06156 Perugia, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Favilli
authors.affiliation: "Arbor Vitae" Centre, Clinica Nuova Villa Claudia, 00191 Rome, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Horvath
authors.affiliation: "Arbor Vitae" Centre, Clinica Nuova Villa Claudia, 00191 Rome, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Grasso
authors.affiliation: Department of Obstetrics and Gynecology, University of Perugia, S.M. della Misericordia Hospital, 06156 Perugia, Italy.
authors.forename: Gian Carlo
authors.initials: GC
authors.lastname: Di Renzo
authors.affiliation: Department of Obstetrics and Gynecology, University of Perugia, S.M. della Misericordia Hospital, 06156 Perugia, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Laurenti
authors.affiliation: Department of Obstetrics and Gynecology, University of Perugia, S.M. della Misericordia Hospital, 06156 Perugia, Italy.
authors.forename: Vittorio
authors.initials: V
authors.lastname: Bini
authors.affiliation: Department of Obstetrics and Gynecology, University of Perugia, S.M. della Misericordia Hospital, 06156 Perugia, Italy. Electronic address: sandro.gerli@unipg.it.
authors.forename: Sandro
authors.initials: S
authors.lastname: Gerli
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002584:Cervix Uteri / Q000033:anatomy & histology*; D005260:Female; D006801:Humans; D015907:Hysteroscopy / Q000009:adverse effects*; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D010146:Pain / Q000175:diagnosis / Q000209:etiology*; D010147:Pain Measurement; D010298:Parity; D010865:Pilot Projects; D011446:Prospective Studies; D012307:Risk Factors; D055815:Young Adult
keywords: Cervical canal; Cervical synechiae; Diagnostic hysteroscopy; Office hysteroscopy; Pain; VAS