The Effect of the Valsalva Maneuver in Endometrial Biopsy: A Randomized Controlled Trial

Endometrial sampling using a pipelle device is a widely used, minimally invasive procedure for the evaluation of abnormal uterine bleeding and other endometrial pathologies. In the conventional technique, cervical traction with a tenaculum is often used to stabilize the cervix and facilitate insertion of the pipelle catheter. However, the use of a tenaculum may increase procedure-related pain and anxiety.

The Valsalva maneuver increases intra-abdominal pressure and may provide temporary stabilization of the uterus and cervix. This physiological effect may facilitate pipelle insertion without the need for cervical traction. Eliminating the use of a tenaculum may reduce patient discomfort and anxiety during the procedure.

This study is designed to compare pipelle endometrial sampling performed with the Valsalva maneuver and the conventional method using a tenaculum. The primary objectives are to evaluate pain perception during the procedure and procedure success. Secondary outcomes include patient anxiety and overall patient satisfaction.

Inclusion criteria

-Endometrial sampling indication in reproductive age group of patients over 18 years of age, who can communicate in Turkish.

Exclusion criteria

• Patients under 18 years of age - postmenopausal
• Pregnancy
• Patients with known stenotic cervical os
• Patients with a history of acute cervicitis;
• Patients with intense anxiety;
• Need for simultaneous endocervical curettage;
• Need for general or local anesthesia
• Having used analgesic medication before the procedure;
• History of a known malignancy, uterine anomaly, or leiomyoma affecting the cervical canal or uterine cavity, or uterine prolapse;
• Patients with known chronic plevic pain