Evaluation of pain in three hysterosalpingography techniques: Metal cannula with and without paracervical blockage and balloon catheter

OBJECTIVE. The objective of this study was to assess discomfort or pain in patients undergoing hysterosalpingography using three different techniques. SUBJECTS AND METHODS. Eighty-nine patients were randomly assigned to one of three groups. In group 1, 30 patients underwent the technique performed with a metal cannula without anesthetic; in group 2, 29 patients underwent the technique performed with a metal cannula with previous paracervical anesthetic block; in group 3, 30 patients submitted to the procedure performed with a flexible balloon catheter. Each patient completed two questionnaires, Q1 and Q2: Q1 assessed their personal, clinical, and surgical history, and Q2 provided the visual analog scale (VAS) for pain assessment. The investigator also evaluated discomfort at each potentially painful stage of the procedure based on the patient's verbal expression, physical manifestations, or both. RESULTS. In terms of global discomfort experienced during hysterosalpingography, group I had the highest mean VAS score, whereas scores did not significantly differ between groups 2 and 3. During cervical grasping, group 2 experienced less discomfort than group 1. A comparison of pain associated with cervical grasping and balloon inflation (group 3 only) revealed that the highest levels of discomfort occurred during cervical grasping without anesthesia (group 1), followed by balloon inflation inside the cervix (group 3), and, last, cervical grasping after paracervical block (group 2). CONCLUSION. Performing hysterosalpingography with a flexible balloon catheter or metal cannula with previous paracervical block produced similar levels of pain; however, both techniques appear to be more comfortable than the traditional technique (i.e., metal cannula without anesthesia).