Verbal Analgesia Versus Standard Care for Pain Control in Women With Primary Infertility Undergoing Office Hysteroscopy

Office hysteroscopy is a cornerstone in the diagnostic evaluation of infertile women, enabling direct visualization of the uterine cavity for identifying intrauterine pathology. The vaginoscopic ("no-touch") approach, which eliminates the use of a speculum and tenaculum, is increasingly adopted due to improved tolerability, higher success rates, and reduced pain compared to conventional methods.

Despite this, many women still report moderate to severe pain, particularly during cervical passage and uterine distension. High pain scores may result in incomplete examinations, decreased patient satisfaction, and increased need for sedation or analgesia. Various pharmacological interventions have been studied, including NSAIDs, local anesthetics, and misoprostol, with inconsistent or limited benefit.

Verbal analgesia, a structured communication strategy involving calm, supportive, and reassuring verbal cues, has been shown to reduce procedural pain in other gynecologic settings such as IUD insertion. However, no randomized trial has specifically evaluated structured verbal analgesia in women with primary infertility undergoing vaginoscopic office hysteroscopy. This trial aims to address this evidence gap by comparing verbal analgesia with standard neutral communication, with both groups receiving baseline NSAID premedication.

Inclusion criteria

• o Women aged 18-40 years.

• Diagnosis of primary infertility (failure to conceive after ≥12 months of unprotected intercourse).
• Indication for diagnostic office hysteroscopy.
• Regular menstrual cycles.

Exclusion criteria

• o Secondary infertility.

• Known pelvic infection, cervicitis, or vaginitis.
• Use of analgesics within 8 hours prior to procedure.
• Cervical stenosis, prior failed hysteroscopy, or known uterine anomaly.
• Contraindication to NSAIDs
• Pregnancy or suspected pregnancy.