Design: Randomized Controlled Trial

Setting: In-office setting at a University Medical Center.

Patients or Participants: Women who underwent in-office hysteroscopy.

Interventions: Subjects were randomly assigned in a 1:1 to one of two groups, the "anticipated discomfort group", where a script using words associated with painful sensation was used (ex. "You are now going to feel a lot of pressure"), or the "objective description group", where an objective description of the steps of the procedure was used (ex. "I am going to introduce the hysteroscope") The same expert hysteroscopist performed all the procedures using the vaginoscopy "No Touch" technique using a 5 mm continuous flow hysteroscope with a 30^o lens. No anesthesia or preoperative medications were given. The anticipated expected pain and the pain level perceived during the procedure were measured using the Visual Analog Scale. Two sample t-test and Fisher's exact test were implemented to compare the perception of pain between groups.

Measurements and Main Results: 35 patients were randomly allocated to each group. Patients in the anticipated discomfort group reported a statistically significant higher discomfort level after the procedure (6.1, SD=2.3 vs 1.3 SD=1.0) (p<.001). There was also a statistically significant difference between the expected pain and the actual perceived pain for patients in the anticipated discomfort group (1.8 SD=3.1) compared to the objective group (5.0 SD=2.0) (p<.001)

Conclusion: Using words associated to unpleasant sensation during Hysteroscopy increases the perception of pain and discomfort experienced by the patient during the procedure. We strongly recommend providing an objective description of the steps and avoiding using words associated with pain when communicating with patients during in-office hysteroscopic procedures.