Pain and anxiety in office histeroscopy

ABSTRACT

SUMMARY BACKGROUND: Anxiety is almost always present before medical interventions and may play a role in pain perception. We aim to evaluate factors associated with pain intensity reported by patients submitted to Office Hysteroscopy (OH). METHODS: Cross-sectional observational study, with data from April to November 2015. It included patients attended at the Assis Chateaubriand Maternity School (MEAC/UFC) with an indication of office hysteroscopy. Before the examination, the patients answered a validated questionnaire about anxiety (STAI). After the examination, women answered the Visual Analogue Scale (VAS). The data were analyzed using the Statistical Package for the Social Sciences (SPSS) 15.0, with Spearman correlation, Mann-Whitney U-test, and analyses of variance. RESULTS: 252 patients were included, with a mean age of 45.7 years, of whom 29% were postmenopausal (mean pain 5.5) and 71% were in menacme (mean pain 5.1) (p = 0.258). The anxiety trait and state showed a significant influence on the pain scale (p <0.001 and p=0.001), but age or endometrial sample did not. 27% of the patients were nulliparous. Less pain was associated with the number (p=0.01) and vaginal (p=0.005) of deliveries. The main indication for the procedure was abnormal uterine bleeding (54.4%). CONCLUSION: OH may be associated with moderate but tolerable discomfort. There was a significant correlation between higher scores on the pain scale and anxiety. There was evidence of reduced pain with parity and type of delivery, but not with reproductive age or endometrial biopsy.

RESUMO

RESUMO INTRODUÇÃO: A ansiedade está quase sempre presente antes de intervenções médicas e pode desempenhar um papel importante na percepção da dor. Buscou-se avaliar os fatores associados à intensidade da dor relatados pelos pacientes submetidos a histeroscopia ambulatorial (HA). MÉTODOS: Estudo observacional transversal, com dados de abril a novembro de 2015. Foram incluídas pacientes atendidas na Maternidade Escola Assis Chateaubriand (Meac/UFC) com indicação de HA. Antes do exame, as pacientes responderam a um questionário validado sobre ansiedade (IAM). Após o exame, as mulheres responderam à Escala Visual Analógica (EVA). Os dados foram analisados no Statistical Package for the Social Sciences (SPSS) 15.0, com correlação de Spearman, teste U de Mann-Whitney e Anova. RESULTADOS: Foram incluídas 252 pacientes, com idade média de 45,7 anos, das quais 29% estavam na pós-menopausa (dor média 5,5) e 71% eram menacme (dor média 5,1) (p = 0,258). O traço e o estado de ansiedade mostraram influência significativa na escala de dor (p<0,001 e p=0,001). Vinte e sete por cento das pacientes eram nulíparas. Menor dor foi associada ao número (p=0,01) e tipo vaginal (p=0,005) de partos. A principal indicação para o procedimento foi sangramento uterino anormal (54,4%); 66,1% necessitaram de amostra endometrial. CONCLUSÕES: A HA pode estar associada a um desconforto moderado, mas tolerável. Houve correlação significativa entre escores mais altos na escala de dor e ansiedade, menor paridade, mas não com idade reprodutiva ou procedimento de biópsia endometrial.