Pain Control during Outpatient Operative Hysteroscopy: What do we know nowdays?

Pain is the primary cause of failure of hysteroscopy. It is attributable to multiple causes, such as manipulation of the cervical canal, uterine distention due to the liquid means of distension used during the procedure, operative procedures on the endometrial mucosa, up to the release of prostaglandins following manipulation of the cervix and uterine distension. There are few studies in the literature that have compared the various methods of pain control during hysteroscopic examination; so far there is no review that defines which are the best strategies to implement. For this reason, the aim of this Review is to summarize what we know today about pain control during Outpatient Operative Hysteroscopy, and to clarify what could be the best strategies to make the hysteroscopic examination increasingly tolerable for the patients and consequently to increasingly limit entrances to the operating room.