ABSTRACT
OBJECTIVES: To evaluate perception of pain during Fallopian-tube patency testing by hysterosalpingo-foam sonography (HyFoSy). METHODS: In this cross-sectional study, 216 consecutive women presenting at a university fertility clinic for HyFoSy examination were included. Patients were instructed to take ibuprofen 1 hour before the procedure. Immediately after the procedure, patients filled in a questionnaire concerning discomfort or pain experienced during the process, including a visual analog scale (VAS) score for perception of pain. RESULTS: The median VAS score for perception of pain during transvaginal ultrasound examination and during HyFoSy examination was 1.5 (95% CI, 1.2-1.7) and 3.6 (95% CI, 3.0-4.0), respectively. One-third of women reported that the level of discomfort or pain during HyFoSy examination was similar to that during the preceding transvaginal ultrasound examination and 48% of women considered HyFoSy examination to be neutral/unpleasant, but not painful. There was an inverse association between both patients' age and parity and the pain experienced. CONCLUSIONS: HyFoSy examination is tolerated well and allows for reliable tubal patency testing without exposing the patient to ionizing radiation in an outpatient setting with a low technical failure rate.
Subject(s)
Analgesics, Non-Narcotic/administration & dosage , Fallopian Tube Patency Tests/methods , Fallopian Tubes/pathology , Hysterosalpingography , Ibuprofen/administration & dosage , Infertility, Female/diagnostic imaging , Pain/prevention & control , Vaginal Creams, Foams, and Jellies/administration & dosage , Adult , Cross-Sectional Studies , Fallopian Tube Patency Tests/adverse effects , Female , Humans , Hysterosalpingography/methods , Pain Measurement , Patient Satisfaction , Surveys and Questionnaires , Treatment Outcome , UltrasonographyABSTRACT
BACKGROUND: The development of cancer from adenomyotic foci is a rare occurrence. The diagnosis is frequently delayed because of the absence of tumor in the eutopic endometrium. CASE REPORT: We present a case of a 64-year-old postmenopausal woman with irregular vaginal bleeding and dull abdominal pain. Hysteroscopy was negative and hormonal treatment was continued. Nine months later, persisting symptoms necessitated endometrial biopsy revealing an atrophic endometrium. Hydrosonography suggested an endometrial polyp of 14 x 7 mm with a surrounding regular thin endometrium and a diffusely inhomogeneous ultrasonographic pattern throughout the myometrium. Hysteroscopic excision of the endometrial polyp was performed. Biopsies obtained during operative hysteroscopy showed a well differentiated endometrioid endometrial carcinoma. A laparoscopically assisted vaginal hysterectomy with bilateral salpingo-oophorectomy, pelvic lymphadenectomy and peritoneal cytology was performed. Pathologic examination revealed an atrophic endometrium and a Stage IB (FIGO 2009) well differentiated endometrioid endometrial carcinoma with prominent squamous differentiation originating from nodular adenomyosis. This ectopic localization of the endometrioid carcinoma added to a diagnostic delay of 12 months. CONCLUSION: Endometrial cancer arising from uterine adenomyosis may be difficult to diagnose. Awareness of this entity and careful ultrasonography are likely to reduce diagnostic delay.
