Uterine retroversion as a predictor of pain in outpatient hysteroscopy without anesthesia

Context: The main limitations to the use of outpatient hysteroscopy (OH) without anesthesia or sedation have been pain and low patient tolerance. Among several possible pain predictors, we aimed to assess uterine retroversion (UR) as a reliable pain predictor during OH and at discharge. Methods: This study included data collected from August 2009 to January 2010 at a teaching hospital. Pain was measured using a visual analog scale (VAS; 0-10) at two time points. Women (n=291) were dichotomized according to presence (n=46) or absence of UR (n=245). Associations between UR and possible confounders were tested and no adjustment was necessary. Dichotomous variables were previous uterine curettage, parity, C-section, diabetes, hypertension, smoking, dyspareunia, dysmenorrhea, oral contraceptive use, chronic pelvic pain, aged”50y and endometritis. Ordinal variables were weight, height, age, education and duration of the procedure. To avoid the controversy of self-rated instruments like the VAS, non-parametric tests and multivariate logistic regression were used. Results: Groups with and without UR showed no statistical difference concerning pain scores. Median VAS scores (5th-95th percentiles) showed the same values during OH (5.0/0.0-10.0; p=0.455) and very similar values at discharge (2.0/0.0-9.7 and 2.0/0.0-9.0, respectively; p=0.471). When VAS scores were dichotomized, UR was not significantly associated with pain intensity during OH (p=0.678; OR=1.147, CI 95%: 0.600-2.191) or at discharge (p=0.315; OR=1.469, CI 95%:0.692-3.120). Concerning UR on the interruption of OH, there was no statistically significant association (p=0.151; OR= 2.176, CI 95%:0.736-6.431). Conclusion: Our data don’t support uterine retroversion as an isolated predictor of pain during office histeroscopy or just prior TO discharge.