Immersive virtual reality as analgesia for women during hysterosalpingography: study protocol for a randomized controlled trial.

BACKGROUND: Hysterosalpingography (HSG) is an accepted radiologic diagnostic modality for initial infertility workup, and is generally considered uncomfortable and painful. However, the management of pain related to HSG remains inefficient. As an emerging nonpharmacologic and noninvasive pain control strategy, virtual reality (VR) distraction has been successfully used in areas such as burns, blunt force trauma, hospital-based needle procedures, dental/periodontal procedures, and urological endoscopy patients. This study aims to evaluate the analgesic effect of VR during HSG. METHODS/DESIGN: A single-center, parallel-group, randomized controlled trial will be carried out in the Radiology Department of Yinchuan Women and Children Healthcare Hospital, Yinchuan. A total of 200 participants who are scheduled for HSG will be enrolled in this study. The participants will be randomized (1:1) into two groups: a VR group and a blank control group. The VR group will receive routine care plus immersive VR intervention and the blank control group will receive routine care. Outcomes will be monitored at baseline, immediately after HSG and 15 min after HSG for each group. The primary outcome is the worst pain score during HSG by a visual analog scale (VAS). The secondary outcomes include: affective pain, cognitive pain, and anxiety during the HSG procedure; worst pain within 15 min after HSG; patient satisfaction and acceptance with pain management; physiological parameters; adverse effects; HSG results; and immersion perception score of the VR system (for the VR condition only). DISCUSSION: This study will focus on exploring a simply operated, noninvasive and low-cost analgesia during the HSG procedure. The results of this trial will provide data on the feasibility and safety of VR distraction therapy during HSG. TRIAL REGISTRATION: Chinese Clinical Trial Register, ChiCTR1900021342. Registered on 16 February 2019.

Effect of education and counselling on reducing pain and anxiety in women undergoing hysterosalpingography: A randomised controlled trial.

AIMS AND OBJECTIVES: To investigate the effects of education and counselling on anxiety and pain in women undergoing hysterosalpingography (HSG) as part of infertility treatment. BACKGROUND: The hysterosalpingography has an important diagnostic role in finding the cause of infertility and making a decision on management of treatment. In addition, it is considered a feared procedure in the infertility process and the one about which very little is known. Women often experience anxiety and pain during the HSG procedure. DESIGN: A randomised controlled trial. METHODS: The CONSORT guidelines have been used to describe the methods. Women who were diagnosed with infertility between February-October 2016 were included in the study. The participants were randomised and divided into intervention (52) and control (53) groups. The sociodemographic and obstetric data collection form, the State-Trait Anxiety Inventory and a visual analogue scale were used before the procedure. After the questionnaires were applied to the intervention group, individual learning and counselling sessions were given about the hysterosalpingography process. Brochures were also distributed to the patients for their reference after the learning session. The control group received standard care. RESULTS: When the intervention and control groups were compared, it was found that the education and counselling given before the HSG procedure significantly decreased the level of pain and anxiety felt by women. In addition, a significant positive correlation was found between pain and anxiety after the training in the intervention group. CONCLUSIONS: This study indicates that the education and counselling given to women before the HSG procedure are effective interventions for reducing pain and anxiety in women undergoing HSG. RELEVANCE TO CLINICAL PRACTICE: With the application of HSG education and counselling, and the distribution of brochures to each patient, pain and anxiety can be reduced during the HSG procedure.

Implementing a holistic approach to a radiographer-led Hysterosalpingogram (HSG) service: A review of impact and patient perception.

INTRODUCTION: Radiographer role development has touched boundaries across the multidisciplinary team and more recently branched into the field of gynaecology. Radiographers are now able to perform tasks that were traditionally performed by radiologists and gynaecologists to implement a radiographer-led Hysterosalpingogram (HSG) service. The aims of the study were to (i) implement a radiographer-led HSG service with a view to decreasing waiting times. (ii) To determine ladies perceptions and satisfaction levels. METHOD: Local clinical guidelines were developed with the radiologist/gynaecologist and trainee HSG radiographers. A robust system of work was initiated which required maintaining comprehensive log books to record examinations performed and reports written. These were audited and compared with those of the radiologist. Audit cycles were monitored through Q Pulse to ensure good practise was maintained. Patient satisfaction surveys were developed and distributed to 100 consecutive ladies attending for HSG over a 6 month period from January-July 2017. RESULTS: The radiographer-led service has increased the number of appointment slots offered for HSG's throughout the year as the service now runs every week. HSG's were performed by 5 staff members but now only require 3 staff. A 75% response rate was achieved from the questionnaire survey and shows high patient satisfaction levels. Ladies reported being better informed about their examination resulting in decreased anxiety, concerns and discomfort. CONCLUSION: The implementation of this service has successfully reduced waiting lists for HSG examinations from 14 to 0 weeks. The Trust has saved £15,000 on staff salaries per annum since the service started.

Information seeking and perceptions of anxiety and pain among women undergoing hysterosalpingography.

OBJECTIVE: Hysterosalpingography (HSG) is an accepted diagnostic tool for infertility workup and is considered an invasive procedure that is generally regarded as uncomfortable and painful, though research on psychological consequences is scarce and outdated. The study objective was to investigate women's experience of HSG in terms of fear, anxiety and pain, as compared to colposcopy. STUDY DESIGN: This cross sectional questionnaire study was conducted at two public women's health clinics in Israel between January 2013 and March 2014. 137 women were included in the study. 42 consecutively sampled women referred for outpatient HSG and 95 consecutively sampled women referred for outpatient diagnostic colposcopy. The main outcome measures were: state-trait anxiety, information seeking behavior, fear of pain, fear of the results, retrospective pain. RESULTS: Compared to those undergoing colposcopy, women undergoing HSG expressed significantly higher anxiety prior to the procedure, feared the pain involved more, and rated the procedure as more painful retrospectively. HSG patients tended to report a higher degree of information seeking. Information seeking was correlated with higher anxiety among HSG but not colposcopy patients. CONCLUSION(S): HSG is a highly stressful procedure associated with fear, anxiety, pain and information seeking. Research is needed to find possible ways of ameliorating these emotions and behaviors as they may have negative impact on patient cooperation.

Experiences of Spanish women undergoing hysterosalpingography as part of the infertility process: a phenomenological study.

AIMS AND OBJECTIVES: To describe and understand the experiences and perceptions of women who undergo hysterosalpingography as part of the infertility process. BACKGROUND: Nurses and midwives should conduct research into the emotional aspects of caring for patients undergoing infertility treatment. The hysterosalpingography is considered to be the most feared test in the infertility process and the one about which very little is known. DESIGN: A phenomenological qualitative study. METHODS: Ten Spanish women who had undergone hysterosalpingography participated in this study. In-depth interviews were carried out between October 2012-May 2013. Data analysis was performed with the help of atlas.ti software to identify emerging themes. RESULTS: The experience of the participants who underwent hysterosalpingography during the infertility process is represented by the following three themes: (1) becoming a mother to feel complete as a person and as a woman, with the subthemes 'maternity as a life objective' and 'maternity in terms of gender identity'; (2) infertility--an intimate experience which provokes negative feelings, with the subthemes 'negative feelings regarding own infertility' and 'infertility as an experience that is little shared with others'; (3) Undergoing hysterosalpingography, with the subthemes 'feelings regarding hysterosalpingography', 'treatment by medical providers' and 'areas for improvement regarding the service given by the providers'. CONCLUSION: For women who undergo hysterosalpingography, maternity may be seen as a life objective that could identify them as women. Results suggest that although infertility is experienced with negative feelings such as anxiety, frustration and sadness, hysterosalpingography seems to be related with both hope and fear when facing the test. RELEVANCE TO CLINICAL PRACTICE: Knowing the experiences of these women could help nurses, midwives and physicians to provide better patient-centred care.

The effect of preprocedure anxiety levels on postprocedure pain scores in women undergoing hysterosalpingography.

BACKGROUND: Hysterosalpingography (HSG) is an invasive, uncomfortable, and painful procedure. Patients often experience considerable anxiety and stress before the procedure. In this study, we aimed to evaluate the effect of preprocedure anxiety on postprocedure pain scores and clinical outcomes in women undergoing HSG. METHODS: This study was designed as a prospective randomized study. Women undergoing HSG were asked to complete the Beck Anxiety Inventory before the procedure. Patients were classified into two groups according to the anxiety score (Group 1: anxiety score ≤ 25; n = 84 and Group 2: anxiety score > 25, n = 25). All of the patients were asked to state the severity of their pain during the procedure using a visual analogue scale immediately after the procedure. Then, postprocedure pain scores and clinical features were evaluated. Data analyzed were: age, gravidity, parity, durations of marriage and infertility, body mass index, procedure time, amount of contrast media used, operator sex, history of surgery, educational level, and HSG results. RESULTS: A total of 109 women were enrolled into this prospective study. There was no statistically significant difference between the groups in terms of age, body mass index, durations of marriage and infertility, procedure time, amount of contrast media used, operator sex, history of surgery, educational level, and patency of the one and/or two fallopian tubes (p > 0.05). The median parity and pain scores after the procedure were lower in Group 1 (p < 0.05). There was also a positive correlation between anxiety scores and postprocedure pain scores (r = 0.289, p = 0.002). Receiver operator characteristics curve analysis demonstrated that operator sex was an important risk factor for postprocedure pain in patients with a preprocedure Beck Anxiety Inventory > 25. Logistic regression method demonstrated that higher parity, preprocedure anxiety score > 25, and male operator were risk factors for increased postprocedure visual analogue scale scores. CONCLUSION: According to this study, preprocedure anxiety levels have an effect on postoperative pain scores in women undergoing HSG procedure. Multiparity, male operator, and higher preprocedure anxiety scores also may have an effect on postoperative pain scores.

Effectiveness of a single education and counseling intervention in reducing anxiety in women undergoing hysterosalpingography: a randomized controlled trial.

Hysterosalpingography (HSG) is generally considered a stressful and painful procedure; we aimed to evaluate whether a single education and counseling intervention could reduce women's distress and pain after undergoing HSG for infertility. Patients were randomized into control group (n = 108) and intervention group (n = 109). All patients filled the following questionnaires before and after HSG: Zung self-rating anxiety scale (Z-SAS), Zung self-rating depression scale (Z-SDS), and an ad hoc questionnaire designed to evaluate HSG procedure knowledge. Pain was scored using a visual analog scale. The intervention consisted in a 45-minute individualised session 48 h before HSG. We observed a reduction of anxiety and depression scores in the intervention arm compared to the control group. After controlling for potential confounding variables, intervention was an independent predictor of the difference of Z-SAS score before and after HSG. This is the first randomised controlled trial to assess the potential effectiveness of a single education and counseling intervention to lower anxiety in a diagnostic setting.

Exploring the needs and expectations of women presenting for hysterosalpingogram examination following a period of subfertility: a qualitative study.

AIMS: This study examines women's experience of healthcare following the referral for hysterosalpingography (HSG) after a period of subfertility. These otherwise fit and healthy women enter the healthcare system and their only problem is a failure to become pregnant. They find themselves trying to negotiate a system designed for sick people. Previous research in this field consists mainly of studies comparing HSG to other diagnostic studies. The study aims to address the underlying issues that women have at the start of their subfertility investigations. METHODS: This qualitative study uses grounded theory methodology. Interviews with women were undertaken immediately prior to their HSG examination. Ten women were interviewed using 12 core questions. Each woman had a diagnosis of primary subfertility. Each was asked how they were coping with the uncertainty of their fertility. They were asked about their expectations of the HSG examination, the importance of HSG and what methods were available to them to reduce any anxiety experienced. Data analysis was undertaken after each interview. RESULTS: Presently, HSG is seen by healthcare providers as a routine outpatient examination at the start of subfertility investigations. In contrast to this, it was discovered at interview that HSG was seen by the women as a defining moment that would signpost their future treatment options to become pregnant. Women reported receiving little support from health care providers, and that written information given did not fulfil all of their needs. Often written information alone heightened anxiety, and this written information needs to be tailored to a specific set of circumstances. The literature review noted that anxiety can lead to mental health issues, but that properly focused, correctly given, timely information can reduce anxiety. CONCLUSIONS: The implications of the findings are that if anxiety relating to treatment at this early stage can be managed effectively, it could minimise the possible physical and emotional trauma to the woman as her subfertility journey continues, thus at the same time preventing future anxiety related illness.

Impact of demographic and psychosocial factors on hysterosalpingography pain and discomfort

Background: Hysterosalpingography (HSG) is an important diagnostic procedure in the investigation of infertility. It is the radiographic delineation of uterine and tubal cavities and is part of the diagnostic evaluation of conjugal infertility.1 This diagnostic procedure is associated with high levels of anxiety, pain and stress from various causes. This study was designed to investigate the impact of demographic and psychosocial factors on HSG pain and discomfort. Method: One hundred hysterosalpingography referrals were recruited for this study. Verbal detector scales were used to assess pain perception, Likert scales were used to assess the psychosocial variables, while visual analogue scales were used to assess discomfort. Pearson's correlations were conducted. Tests were two-tailed, with p < 0.05 indicating statistical significance. Results: Some of the patients (34%) indicated that the administration of analgesics prior to the procedure reduced the pain and discomfort associated with the procedure. Mean ± standard deviation of pain and discomfort were 2.82 ± 0.77 and 6.36 ± 2.19 respectively. Age correlated signifi cantly with pain perception (r = -0.22, P < 0.05), while pain correlated signifi cantly with perception of discomfort(r = -0.46, P < 0.05). Conclusion: Age signifi cantly correlated with pain. This is a factor that could be harnessed for clinical use

Physical complaints and emotional stress related to routine diagnostic procedures of the fertility investigation.

The aim of this study was to map out the extent of the physical complaints and emotional stress due to diagnostic routines of the infertility work-up. To this end a questionnaire was sent to 96 consecutive couples visiting an infertility clinic of a university hospital. The results indicate that women often have physical complaints as a result of the hysterosalpingography (59%) and the diagnostic laparoscopy (47%) and mostly experience these diagnostic procedures as very stressful. Both the postcoital test and the semen analysis caused a moderate amount of stress. The other diagnostic procedures, including physical examination of both sexes, recording of the basal temperature and taking blood for hormonal determinations, were accompanied by fewer complaints and much less stress. It is concluded that the role of the hysterosalpingography and the diagnostic laparoscopy in the routine infertility work-up needs to be reconsidered in view of the burden they pose to the women involved.

Patients' perception of the hysterosalpingogram: the initial stages of the audit cycle.

A prospective study of 98 consecutive hysterosalpingogram examinations was undertaken to evaluate patients' understanding of the examination, to assess their anxiety levels and to identify any factors where improvements might alleviate this anxiety. This was achieved by employing three simple questionnaires, two being completed by the patient (before and after the examination), the third being completed by the radiologist who recorded clinical and technical details. In this study the majority of patients knew why the examination was being performed, although only 50% had received an explanation of the technique prior to their arrival in the department. Anxiety levels associated with the examination were high. The importance of a sympathetic approach by the radiologist prior to the examination was highlighted, and it was found that time delays contributed to the anxiety level.