{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T17:14:10Z","timestamp":1792689250663,"version":"4.5.0"},"reference-count":37,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2024,11,21]],"date-time":"2024-11-21T00:00:00Z","timestamp":1732147200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Hysteroscopy is an endoscopic diagnostic and therapeutic method traditionally performed under general anesthesia but increasingly under local anesthesia. Today, it is considered the gold standard in gynecology. This minimally invasive procedure allows for a detailed assessment of the uterine cavity\u2019s interior and the removal of abnormal changes within it and is applicable to patients of all ages. Background\/Objectives: The purpose of the present study was to evaluate pain during hysteroscopy under local anesthesia at different stages of the procedure, identifying which stage is the most painful (GUBBINI Mini Hystero-Resectoscope; Tontarra Medizintechnik, Tuttlingen, Germany). Methods: The study included patients between the ages of 21 and 80 years. They were divided into two groups: the diagnostic hysteroscopy (HD) and the operative hysteroscopy (HO) groups. Pain measurements on the VAS scale were taken at each stage of the hysteroscopic procedure. After each stage, the operator asked the patient to indicate the maximum perceived pain value: after pericervical anesthesia was administered (VAS1), during the installation of equipment (between the removal of the speculum and the insertion of the hysteroscope into the vagina) (VAS2), after insertion of the hysteroscope and visualization of the external orifice of the cervical canal (VAS3), after passage of the hysteroscope through the cervical canal (VAS4), and after completion of the procedure in the uterine cavity (VAS5). The duration of each stage of the procedure was measured with a stopwatch: administration of pericervical anesthesia (T1), time between the removal of the speculum and the insertion of the hysteroscope into the vagina (T2), insertion of the hysteroscope into the vagina until the outer orifice of the cervical canal became visible (T3), passage of the hysteroscope through the cervical canal (T4), and the hysteroscopy procedure itself (T5). Results: The highest pain rating was for the canal passage stage (VAS4: 2.47 \u00b1 2.48 points), followed by the procedure itself (VAS5: 2.12 \u00b1 2.33 points). Anesthesia was also reported as quite painful, while the lowest pain was noted during the assembly stage. Overall pain scores for the entire procedure (VASmax) ranged from 3.5 \u00b1 2.37. Conclusion: In conclusion, we found that the passage through the cervical canal was the most painful moment. Overall, hysteroscopy under pericervical anesthesia was not associated with significant pain. Special attention should be given to postmenopausal patients, as they experience more pain during the passage of the hysteroscope through the cervical canal. This group may benefit from additional pain management strategies during the procedure.<\/jats:p>","DOI":"10.3390\/jcm13237030","type":"journal-article","created":{"date-parts":[[2024,11,21]],"date-time":"2024-11-21T12:24:51Z","timestamp":1732191891000},"page":"7030","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Evaluation of Pain During Hysteroscopy Under Local Anesthesia, Including the Stages of the Procedure"],"prefix":"10.3390","volume":"13","author":[{"given":"Adrian","family":"Nowak","sequence":"first","affiliation":[{"name":"Department of Maternal and Child Health and Minimally Invasive Surgery, Poznan University of Medical Sciences, 60-701 Poznan, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2299-8353","authenticated-orcid":false,"given":"Karolina","family":"Chmaj-Wierzchowska","sequence":"additional","affiliation":[{"name":"Department of Maternal and Child Health and Minimally Invasive Surgery, Poznan University of Medical Sciences, 60-701 Poznan, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Agnieszka","family":"Lach","sequence":"additional","affiliation":[{"name":"Department of Maternal and Child Health and Minimally Invasive Surgery, Poznan University of Medical Sciences, 60-701 Poznan, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"Malinger","sequence":"additional","affiliation":[{"name":"Department of Maternal and Child Health and Minimally Invasive Surgery, Poznan University of Medical Sciences, 60-701 Poznan, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maciej","family":"Wilczak","sequence":"additional","affiliation":[{"name":"Department of Maternal and Child Health and Minimally Invasive Surgery, Poznan University of Medical Sciences, 60-701 Poznan, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,11,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1016\/j.jmig.2010.01.015","article-title":"Office Vaginoscopic Hysteroscopy in Infertile Women: Effects of Gynecologist Experience, Instrument Size, and Distention Medium on Patient Discomfort","volume":"17","author":"Pluchino","year":"2010","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Vitale, S.G., Sapia, F., Rapisarda, A.M.C., Valenti, G., Santangelo, F., Rossetti, D., Chiofalo, B., Sarpietro, G., La Rosa, V.L., and Triolo, O. (2017). Hysteroscopic Morcellation of Submucous Myomas: A Systematic Review. BioMed Res. Int., 2017.","DOI":"10.1155\/2017\/6848250"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1007\/s00404-016-4244-1","article-title":"Endometrial Preparation with Dienogest before Hysteroscopic Surgery: A Systematic Review","volume":"295","author":"Vitale","year":"2017","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Gullo, G., Etrusco, A., Cucinella, G., Perino, A., Chiantera, V., Lagan\u00e0, A.S., Tomaiuolo, R., Vitagliano, A., Giampaolino, P., and Noventa, M. (2021). Fertility-Sparing Approach in Women Affected by Stage I and Low-Grade Endometrial Carcinoma: An Updated Overview. Int. J. Mol. Sci., 22.","DOI":"10.3390\/ijms222111825"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Moawad, N.S., Santamaria, E., Johnson, M., and Shuster, J. (2014). Cost-Effectiveness of Office Hysteroscopy for Abnormal Uterine Bleeding. J. Soc. Laparosc. Robot. Surg., 18.","DOI":"10.4293\/JSLS.2014.00393"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1016\/j.rbmo.2013.02.015","article-title":"Cost-Effectiveness of Hysteroscopy Screening for Infertile Women","volume":"26","author":"Kasius","year":"2013","journal-title":"Reprod. Biomed. Online"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1111\/j.1479-828X.2008.00834.x","article-title":"Audit of Endometrial Biopsy at Outpatient Hysteroscopy","volume":"48","author":"Ghaly","year":"2008","journal-title":"Aust. N. Z. J. Obstet. Gynaecol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"896","DOI":"10.1111\/j.1471-0528.2006.00967.x","article-title":"A Randomised Controlled Trial Comparing Outpatient versus Daycase Endometrial Polypectomy","volume":"113","author":"Marsh","year":"2006","journal-title":"BJOG Int. J. Obstet. Gynaecol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1016\/S0015-0282(03)00546-6","article-title":"Reliability, Feasibility, and Safety of Minihysteroscopy with a Vaginoscopic Approach: Experience with 6000 Cases","volume":"80","author":"Cicinelli","year":"2003","journal-title":"Fertil. Steril."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"532","DOI":"10.1111\/j.1471-0528.2010.02503.x","article-title":"Vaginoscopic Approach to Outpatient Hysteroscopy: A Systematic Review of the Effect on Pain","volume":"117","author":"Cooper","year":"2010","journal-title":"BJOG Int. J. Obstet. Gynaecol."},{"key":"ref_11","first-page":"104","article-title":"Too Big? A Review of Methods for Removing Large Endometrial Polyps in Office Minihysteroscopy\u2014Broadening the Indications for the Procedure in the COVID-19 Pandemic","volume":"17","author":"Biela","year":"2022","journal-title":"Videosurgery Miniinvasive Tech."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1097\/AOG.0b013e31825b9086","article-title":"Using a 16-French Resectoscope as an Alternative Device in the Treatment of Uterine Lesions: A Randomized Controlled Trial","volume":"120","author":"Ricciardi","year":"2012","journal-title":"Obstet. Gynecol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1007\/s00404-013-2754-7","article-title":"New Mini-Resectoscope: Analysis of Preliminary Quality Results in Outpatient Hysteroscopic Polypectomy","volume":"288","author":"Dealberti","year":"2013","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1136\/bmj.320.7230.279","article-title":"Patient Satisfaction with Outpatient Hysteroscopy versus Day Case Hysteroscopy: Randomised Controlled Trial","volume":"320","author":"Kremer","year":"2000","journal-title":"BMJ"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/S1074-3804(00)80011-0","article-title":"Operative Hysteroscopy in the Office Setting","volume":"7","author":"Lindheim","year":"2000","journal-title":"J. Am. Assoc. Gynecol. Laparosc."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Ignaszak-Kaus, N., Chmaj-Wierzchowska, K., Nowak, A., Wszo\u0142ek, K., and Wilczak, M. (2022). An Overview of Outpatient Hysteroscopy. Clin. Exp. Obstet. Gynecol., 49.","DOI":"10.31083\/j.ceog4908181"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1097\/00006254-200210000-00023","article-title":"Pain Control in Outpatient Hysteroscopy: Obstet","volume":"57","author":"Yang","year":"2002","journal-title":"Gynecol. Surv."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1111\/j.1479-828X.1993.tb02056.x","article-title":"Side-Effects and Complications of Outpatient Hysteroscopy","volume":"33","author":"Finikiotis","year":"1993","journal-title":"Aust. N. Z. J. Obstet. Gynaecol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1093\/humupd\/5.1.73","article-title":"Office Mini-Hysteroscopy","volume":"5","author":"Campo","year":"1999","journal-title":"Hum. Reprod. Update"},{"key":"ref_20","unstructured":"(2024, June 15). Palliative Care. Available online: https:\/\/www.who.int\/westernpacific\/health-topics\/palliative-care."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1016\/j.jmig.2017.08.009","article-title":"Office Operative Hysteroscopy: An Update","volume":"25","author":"Salazar","year":"2018","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1063","DOI":"10.1007\/s00404-022-06572-7","article-title":"Opinion Paper: Gynecological Surgery in Local Anesthesia?","volume":"306","author":"Neis","year":"2022","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1080\/13697137.2020.1754388","article-title":"Pharmacological and Non-Pharmacological Pain Relief for Office Hysteroscopy: An up-to-Date Review","volume":"23","author":"Riemma","year":"2020","journal-title":"Climacteric"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Chmaj-Wierzchowska, K., Wszo\u0142ek, K., Nowak, A., Ignaszak-Kaus, N., Muszy\u0144ska, M., and Wilczak, M. (2022). Evaluation of Stress Hormone Levels, Preoperative Anxiety, and Information Needs before and after Hysteroscopy under Local Anesthesia in Relation to Transvaginal Procedures under General, Short-Term Anesthesia. Clin. Exp. Obstet. Gynecol., 49.","DOI":"10.31083\/j.ceog4912278"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1097\/AOG.0000000000002790","article-title":"Paracervical Block for Intrauterine Device Placement Among Nulliparous Women: A Randomized Controlled Trial","volume":"132","author":"Mody","year":"2018","journal-title":"Obstet. Gynecol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1633","DOI":"10.1590\/1806-9282.66.12.1633","article-title":"Pain and Anxiety in Office Histeroscopy","volume":"66","author":"Rolim","year":"2020","journal-title":"Rev. Assoc. M\u00e9dica Bras."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1016\/j.ejogrb.2007.11.008","article-title":"Outpatient Operative Polypectomy Using a 5mm-Hysteroscope without Anaesthesia and\/or Analgesia: Advantages and Limits","volume":"139","author":"Litta","year":"2008","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Chiofalo, B., Calandra, M., Bruno, V., Tarantino, V., Esposito, G., Vizza, E., Corrado, G., Scambia, G., and Catena, U. (2023). Outpatient Hysteroscopic Polypectomy\u2014A Retrospective Study Comparing Rigid and Semirigid Office Hysteroscopes. Diagnostics, 13.","DOI":"10.3390\/diagnostics13050988"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1016\/j.jgyn.2016.02.007","article-title":"Office Hysteroscopy: A Report of 2402 Cases","volume":"45","author":"Capmas","year":"2016","journal-title":"J. Gyn\u00e9cologie Obst\u00e9trique Biol. Reprod."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Cooper, N.A.M., Clark, T.J., Middleton, L., Diwakar, L., Smith, P., Denny, E., Roberts, T., Stobert, L., Jowett, S., and Daniels, J. (2015). Outpatient versus Inpatient Uterine Polyp Treatment for Abnormal Uterine Bleeding: Randomised Controlled Non-Inferiority Study. BMJ, 350.","DOI":"10.1136\/bmj.h1398"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Nowak, A., Chmaj-Wierzchowska, K., Kampioni, M., Malinger, A., and Wilczak, M. (2023). Evaluation of Pain during Diagnostic and Surgical Minihysteroscopy under Local Anesthesia. Arch. Med. Sci.","DOI":"10.5114\/aoms\/169979"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1111\/j.1479-828X.1997.tb02254.x","article-title":"Outpatient Hysteroscopy\u2014Problems","volume":"37","author":"Bellingham","year":"1997","journal-title":"Aust. N. Z. J. Obstet. Gynaecol."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Cooper, N.A.M., Khan, K.S., and Clark, T.J. (2010). Local Anaesthesia for Pain Control during Outpatient Hysteroscopy: Systematic Review and Meta-Analysis. BMJ, 340.","DOI":"10.1136\/bmj.c1130"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"885","DOI":"10.1007\/s00404-020-05460-2","article-title":"Management of Anxiety and Pain Perception in Women Undergoing Office Hysteroscopy: A Systematic Review","volume":"301","author":"Vitale","year":"2020","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"904","DOI":"10.1111\/jog.14608","article-title":"Use of Music in Reducing Pain during Outpatient Hysteroscopy: Prospective Randomized Trial","volume":"47","author":"Law","year":"2021","journal-title":"J. Obstet. Gynaecol. Res."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1007\/s13669-024-00377-y","article-title":"An Overview of Office Hysteroscopy","volume":"13","author":"Wright","year":"2024","journal-title":"Curr. Obstet. Gynecol. Rep."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1034","DOI":"10.1016\/j.jmig.2020.01.008","article-title":"Analgesia for Office Hysteroscopy: A Systematic Review and Meta-Analysis","volume":"27","author":"Mahmud","year":"2020","journal-title":"J. Minim. Invasive Gynecol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/23\/7030\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:36:53Z","timestamp":1760114213000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/23\/7030"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,21]]},"references-count":37,"journal-issue":{"issue":"23","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["jcm13237030"],"URL":"https:\/\/doi.org\/10.3390\/jcm13237030","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11,21]]}}}