Patient Perspectives on Pain During Ambulatory Gynecologic Procedures

Introduction: Pain perception during pelvic exams and gynecologic procedures varies widely and may be influenced by psychological, physiological, and clinical factors. Understanding patient experiences and desired interventions is critical to improving care and reducing unacceptable pain. Methods: We conducted a cross-sectional, retrospective survey of patients seen at an ambulatory gynecology clinic within an academic medical center in Portland, Oregon. Eight hundred and twenty-four individuals completed the survey, with 690 meeting inclusion criteria. The primary outcome was acceptability of procedural pain using the Patient Acceptable Symptom State (PASS). Results: Thirteen percent of respondents reported unacceptable PASS during prior pelvic exams or procedures. This was more common among those with dysmenorrhea ( p = 0.002), chronic pelvic pain ( p = 0.006), sexual trauma ( p = 0.04), younger age ( p < 0.001), or undergoing a first pelvic exam ( p = 0.01). Moderate or severe anxiety during their most recent exam or procedure was strongly associated with unacceptable PASS (34.4% versus 23.1%, 54.4% versus 13.5%, p < 0.001), though prior diagnoses of depression/anxiety were not. Compared to the overall sample, transcervical procedure respondents were more likely to report unacceptable PASS (27.7% versus 13.0%) and moderate-to-severe pain (64.5% versus 35.7%). Conclusions: Both patient comorbidities and modifiable clinical practices contribute to unacceptable procedural pain. Patients expressed interest in anxiolytics, moderate sedation, and topical/injectable anesthetic options. Involving patients in pain management decisions and responding to their pain was associated with more acceptable experiences. Further research is needed to evaluate effective interventions across diverse populations and procedures.