An Overview on Pain Associated with Hysteroscopy

Abstract

Outpatient hysteroscopy has become a cornerstone diagnostic and therapeutic procedure in modern gynecological practice due to its high accuracy, safety profile, and cost-effectiveness. Despite its advantages, pain remains the most significant limiting factor affecting patient tolerance, satisfaction, and procedural success. Pain during hysteroscopy arises from multiple sources, including cervical manipulation, uterine distension, endometrial instrumentation, and patient-related factors such as anxiety and cervical anatomy. Various strategies have been explored to minimize pain, ranging from procedural modifications—such as vaginoscopic technique, miniaturized instruments, and choice of distension medium—to pharmacological and non-pharmacological analgesic methods. These include systemic analgesics, antispasmodics, local anesthetic techniques, and adjunctive measures like transcutaneous electrical nerve stimulation. This review aims to provide a comprehensive overview of the mechanisms of pain during hysteroscopy and to critically evaluate current evidence-based approaches for pain management in outpatient settings, with the goal of improving patient comfort and procedural outcomes.