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Incidence of Pain During Hysterosalpingography Using a Balloon Catheter

Columbia University New York, NY

 
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In the July 2006 issue of the American Journal of Roentgenology, de Mello and colleagues [1] concluded that performing hysterosalpingography with a flexible balloon catheter or metal cannula with a previous paracervical block produced similar levels of pain.

The authors indicated that hysterosalpingography balloon inflation was classified as uncomfortable by 23.3% of patients and painful by 10%. The high incidence of pain during balloon inflation may be related to the location of balloon inflation. The authors noted that "the balloon was inflated to the level of the cervical or uterine isthmus." Inflation of the balloon at the uterine isthmus (Fig. 1) rather than at the cervical isthmus frequently causes significant patient discomfort.

View larger version (84K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1 —32-year-old woman with infertility. Normal hysterosalpingogram shows balloon positioned within uterine isthmus (arrow).

Gynecologists have reported that passage of a hysteroscope through the internal cervical os represents a technical obstacle because of related patient discomfort [2]. The diameter of the internal cervical os is approximately 4–5 mm. Passage of a large-diameter hysteroscope will result in stretching of the internal cervical os. The use of smaller-diameter hysteroscopes has been shown to be well tolerated and can be performed as an outpatient procedure [3, 4].

The incidence of pain during hysterosalpingography using a balloon catheter may be significantly reduced if effort is made to avoid inflating the balloon catheter at the uterine isthmus.

References

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1. de Mello JFL Sr, Abrao MS, Cerri GG, de Barros N. Evaluation of pain in three hysterosalpingography techniques: metal cannula with and without paracervical blockage and balloon catheter. AJR2006; 187:86 -89[Abstract/Free Full Text]
2. Bettocchi S, Nappi L, Ceci O, Selvaggi L. What does `diagnostic hysteroscopy' mean today? The role of the new techniques. Curr Opin Obstet Gynecol 2003; 15:303 -308[CrossRef][Medline]
3. Cicinelli E, Parisi C, Galantino P, Pinto V, Barba B, Schonauer S. Reliability, feasibility, and safety of minihysteroscopy with a vaginoscopic approach: experience with 6,000 cases. Fertil Steril2003; 80:199 -202[Medline]
4. Campo R, Molinas CR, Rombauts L, et al. Prospective multicentre randomized controlled trial to evaluate factors influencing the success rate of office diagnostic hysteroscopy. Hum Reprod2005; 20:258 -263[Abstract/Free Full Text]

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				J. F. L. de Mello Sr., M. S. Abrao, and G. G. Cerri Reply Am. J. Roentgenol., July 1, 2007; 189(1): W49 - W49. [Full Text] [PDF]

This Article Figures Only Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Silberzweig, J. E. Search for Related Content PubMed PubMed Citation Articles by Silberzweig, J. E. Social Bookmarking                      What's this? Hotlight (NEW!) What's Hotlight?