Patient’s Acceptance of Outpatient Hysteroscopy

Abstract

There is a trend towards performing hysteroscopy and endometrial biopsy on an outpatient basis, as this alleviates the need for both an inpatient stay and a general anesthesia. Despite the wide acceptance by medical staff, there are few publications on how patients actually tolerate and accept these procedures. We performed a survey on 185 patients attending the outpatient hysteroscopy clinic at a teaching hospital to assess the degree of pain and their acceptance to those procedures using a visual analogue scale. All procedures were successfully performed under no anesthesia without complications. The mean age of the patients was 48 (range 24–78) and 9.4% were nulliparas. The mean pain experienced was 4.7 (SD 2.7) during hysteroscopy and 5.0 (SD 2.9) during endometrial biopsy. The overall preference scores for the procedure to be done under was 3.1 (SD 3.7). About 7% of patients expressed a preference for an overnight stay in hospital after the procedure, but the preference score was low (2.5, SD 3.6). The procedure was well accepted (8.3, SD 2.4) and highly recommended by the patients (8.4, SD 2.9). Outpatient hysteroscopy is well accepted and tolerated by patients.

Evaluation of pain in outpatient diagnostic hysteroscopy with gas

“…The women in this study showed an increase in the pain score, still not statistically significant, but since the biopsy was performed only in 62.1% of the group, and this study was not designed to evaluate biopsy as the main factor, probably the sample group was not high enough to measure the effect of that outcome (4) . It is supposed that a greater acceptance could be reached offering to the patients a detailed explanation of the method, reducing anxiety and expectation (6,12) , but this study showed that the patients who had been previously informed by their doctors about the procedure did not experience any relief in their discomfort. Those submitted to hysteroscopy once before, who knew all steps of the exam, even referred worse pain than those undergoing their first exam.…”

“…Outpatient diagnostic hysteroscopy and endometrial sampling replaced the uterine curettage as the gold standard investigation method for abnormal uterine bleeding and endometrial conditions, providing a precise evaluation of the intrauterine cavity, besides other obvious advantages of no need to use anesthesia or hospitalization (6) . According to different authors, pain is the main limiting factor to the outpatient procedure and one of the causes of impaired accuracy of the exam, sometimes leading to unsatisfactory results (1,(4)(5) .…”

“…Recent articles showed that the use of saline for distension instead of carbon dioxide gas reduces pain, and that vaginoscopy approach, developed by Bettocchi et al, with no need of speculum or tenaculum, seems to be well tolerated by patients (1,4,6,(17)(18)(19)(20)(21) . cOnclUSiOnS Outpatient diagnostic hysteroscopy with gas can be associated with moderate but tolerable discomfort (mean pain score of 6 in a 0 to 10 pain scale, with 91.4% acceptance to repeat the exam), with satisfying results.…”

“…A sample calculation was done considering an standard deviation of 2.7 points (6) , to detect the minimum variation in the verbal pain scale (1.0) with statistical significance defined as p = 0.05 and study power of 95%. It resulted in 43 patients so we had 58 patients randomly assigned by convenience.…”

Three-year experience in outpatient microwave endometrial ablation

“…It seems that the main limitation to the widespread use of outpatient procedures is pain [9]. Therefore, over the past 20 years, there has been a trend towards assessing and performing some procedures in outpatients [10]. Outpatient procedures are associated with fewer anaesthetic risks, reduced hospital admissions, easy access and quick recovery, with no increase in postoperative analgesia [9].…”