Predictors of Pain Associated With Hysterosalpingography (HSG): A Prospective Cohort Study

Predictive factors of pain were evaluated prospectively in a cohort of 157 women undergoing hysterosalpingography (HSG). 94% of women experienced pain associated with the procedure. A history of dysmenorrhea or tubal obstruction at time of procedure was a significant predictor of increased pain associated with HSG. Pre-procedure treatment with Non-Steroidal Anti- Inflammatory Drugs (NSAIDs) was not associated with changes in pain scores. Objective: To identify predictive factors of pain associated with Hysterosalpingography (HSG). Design: Prospective cohort study. Setting: Academic medical center. Patients: 157 consecutive women undergoing HSG as part of infertility evaluation. Interventions: Completion of standardized pre- and post-procedure questionnaires, including Post-Procedure Visual Analog Scale (VAS), Present Pain Intensity (PPI) and Short Form McGill Pain Questionnaire (SF-MPQ). Main Outcome Measures: Prevalence and nature of HSG-associated pain, VAS, PPI and SF-MPQ results, predictors of HSG-associated pain. Results: Of the 157 women undergoing HSG, 94% of patients experienced pain during the procedure. Not surprisingly, the most common description of the nature of pain was “cramping” (86.5%). The severity of reported pre-procedure dysmenorrhea was statistically significantly associated with the occurrence of HSG-associated pain (r=0.315, p<0.01). Additionally, women with tubal obstruction experienced a significant increase in HSG-associated pain (p=0.011). Patients using pre-procedure non-steroidal anti-inflammatory drugs (NSAIDs, 85.4% of women) experienced no significant decreases in VAS pain scores (73.7 versus 82.0, p=0.40). Conclusion: The majority of women experience pain during HSG. A history of dysmenorrhea and a finding of tubal obstruction were statistically significant predictors of HSG-associated pain.Pre-procedure treatment with NSAIDs reduced pain scores, however this was not statistically significant.