Anxiety at outpatient hysteroscopy

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Pietro Gambadauro MD PhD1,2,*, Ramesan Navaratnarajah MBBCh MRCP MRCOG3, Vladimir Carli MD PhD1,4

1. Karolinska Institutet, LIME/NASP-C7, 17177, Stockholm, Sweden; 2. Res Medica Sweden, Uppsala, Sweden; 3. St. Bartholomew’s and the Royal London Hospital, Bart’s Health NHS Trust, Queen Mary University of London, London, UK; 4. WHO Collaborating Centre for Research, Training and Methods Development, and National Centre for Suicide Research and Prevention of Mental lll-Health, Karolinska Institutet, Stockholm, Sweden

Gynecol Surg 2015;12(3):189-196. DOI: 10.1007/s10397-015-0895-3

This review summarises current understanding and research on the association between anxiety and outpatient hysteroscopy. Women undergoing hysteroscopy suffer from significant levels of anxiety, with repercussions on pain perception, success rates and satisfaction. Using validated tools such as the Spielberger State-Trait Anxiety Index (STAI) or the Hospital Anxiety and Depression Scale (HADS) in the outpatient hysteroscopy setting, average state anxiety scores similar or greater than those measured before more invasive procedures under general anaesthesia have been consistently reported. This clearly suggests a significant gap between our clinical viewpoint of what is “minimally invasive” and patients’ expectations. In spite of its potential role of confounder in studies on pain-reduction interventions, we found that patient anxiety was evaluated in only 9 (13 %) out of a sample of 70 randomised controlled trials on outpatient hysteroscopy published since 1992. Factors such as trait anxiety, age, indication and the efficiency of the clinic can be correlated to state anxiety before hysteroscopy, but more robust data are needed. Promising non-pharmacological interventions to reduce anxiety at hysteroscopy include patient education, communication through traditional or multimedia approaches, interaction and support during the procedure and music listening.
Keywords: Hysteroscopy, Anxiety, Pain, Outpatient hysteroscopy, Mental health, Patient-centred care

This work was conducted within eMeRGE, an interdisciplinary research platform for Mental health in Reproduction, Gynaecology and Endometriosis. Parts of this paper were presented by Pietro Gambadauro as an invited lecture at the European Society for Gynaecological Endoscopy (ESGE) 23rd Annual Congress, Brussels, Belgium, on the 24th of September, 2014.
© The Author(s) 2015

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Gynecological Surgery: Anxiety at outpatient hysteroscopy.