The role of uterine anteversion and flexion angles in predicting pain severity during diagnostic hysteroscopy: a prospective cohort study

Abstract

OBJECTIVES: Diagnostic hysteroscopy (DH) is a gold standard diagnostic imaging tool in gynecology. There is insufficient data in the literature regarding the reduction of pain felt during the DH and there is no study in the literature that examines the relationship between the measurement of uterine version or flexion angles and the pain felt during DH procedure. The aim of this study was to investigate the effects of uterine version or flexion angles on pain severity during DH and to identify predictive factors for severe pain experienced during the procedure.
MATERIAL AND METHODS: This prospective single-center cohort study included patients who were eligible for DH within medical indications. Exclusion criteria comprised menopausal status, congenital uterine anomalies, uterine fibroids larger than 2 cm detected on ultrasonography, suspected malignancy, or retroverted uterus. Before hysteroscopy, all patients underwent transperineal ultrasonography to measure uterine version and flexion angles. Patients were asked to rate their pain levels using a 0–10 numerical visual analog scale (VAS). Patients with VAS scores ≥ 6 were categorized into the severe pain group, while those with scores < 6 were classified into the moderate pain group.
RESULTS: The study comprised 98 women undergoing DH. Multivariate binary logistic regression analysis identified anteversion angle and nulliparity as significant predictors of severe pain during DH. The optimal cut-off value for predicting severe pain during DH was identified as 74.5°, providing a sensitivity of 66.7% and specificity of 69.0% [area under curve (AUC) = 0.722, p = 0.001].
CONCLUSIONS: This study demonstrates that a uterine anteversion angle narrower than 74.5° is associated with severe pain during DH.