Hysteroscopy is an endoscopic diagnostic and therapeutic method traditionally performed under general anesthesia but increasingly under local anesthesia. Today, it is considered the gold standard in gynecology. This minimally invasive procedure allows for a detailed assessment of the uterine cavity’s interior and the removal of abnormal changes within it and is applicable to patients of all ages. Background/Objectives: The purpose of the present study was to evaluate pain during hysteroscopy under local anesthesia at different stages of the procedure, identifying which stage is the most painful (GUBBINI Mini Hystero-Resectoscope; Tontarra Medizintechnik, Tuttlingen, Germany). Methods: The study included patients between the ages of 21 and 80 years. They were divided into two groups: the diagnostic hysteroscopy (HD) and the operative hysteroscopy (HO) groups. Pain measurements on the VAS scale were taken at each stage of the hysteroscopic procedure. After each stage, the operator asked the patient to indicate the maximum perceived pain value: after pericervical anesthesia was administered (VAS1), during the installation of equipment (between the removal of the speculum and the insertion of the hysteroscope into the vagina) (VAS2), after insertion of the hysteroscope and visualization of the external orifice of the cervical canal (VAS3), after passage of the hysteroscope through the cervical canal (VAS4), and after completion of the procedure in the uterine cavity (VAS5). The duration of each stage of the procedure was measured with a stopwatch: administration of pericervical anesthesia (T1), time between the removal of the speculum and the insertion of the hysteroscope into the vagina (T2), insertion of the hysteroscope into the vagina until the outer orifice of the cervical canal became visible (T3), passage of the hysteroscope through the cervical canal (T4), and the hysteroscopy procedure itself (T5). Results: The highest pain rating was for the canal passage stage (VAS4: 2.47 ± 2.48 points), followed by the procedure itself (VAS5: 2.12 ± 2.33 points). Anesthesia was also reported as quite painful, while the lowest pain was noted during the assembly stage. Overall pain scores for the entire procedure (VAS_max) ranged from 3.5 ± 2.37. Conclusion: In conclusion, we found that the passage through the cervical canal was the most painful moment. Overall, hysteroscopy under pericervical anesthesia was not associated with significant pain. Special attention should be given to postmenopausal patients, as they experience more pain during the passage of the hysteroscope through the cervical canal. This group may benefit from additional pain management strategies during the procedure.

Introduction: Hysteroscopy is currently considered as gold standard for the diagnosis and treatment of lesions in the uterine cavity and cervical canal. Currently, smaller diameter hysteroscopes are used, which enable the procedure to be performed without general anesthesia. Despite the use of...

(1) Background: Transvaginal RFA is a minimally invasive treatment for myomas in women opting for uterus preservation. The present study aimed to evaluate the efficacy and safety of transvaginal RFA to treat myomas, reduce symptoms, decrease myoma volume, and identify prognostic factors for predicting treatment response. (2) Methods: The study group included 45 women treated for uterine fibroids at the Gynecological and Obstetrics Clinical Hospital in Poznań. From 1 July 2024 to 31 March 2025, a total of 45 transvaginal radiofrequency ablation (TV-RFA) procedures were performed. (3) Results: Ultrasound findings revealed that fibroid dimensions and volume significantly decreased at 1-month follow-up compared to those at pre-procedure (88.7 ± 116.3 vs. 64.6 ± 82.6 cm³; p = 0.003). Ultrasound findings demonstrated that fibroid depth (4.8 ± 2.1 vs. 4.1 ± 2.2; p = 0.01) and fibroid volume (88.7 ± 116.3 vs. 82.4 ± 93.9 cm³; p = 0.02) were significantly decreased at 3-month follow-up compared to their pre-procedure values. Menstrual bleeding duration showed significant differences between the pre-procedure state and 1-month follow-up (N = 23; T = 2; Z = 4.14; p < 0.001) and 3-month follow-up (N = 8; T = 1; Z = 2.38; p = 0.017), with a significant reduction after the RFA procedure. Significant differences were observed in bleeding severity at pre-procedure and at 1-month follow-up (N = 22; T = 11.5; Z = 3.73; p < 0.001); however, no significant differences in bleeding severity were noted at the 3-month follow-up (N = 7; T = 4; Z = 1.69; p = 0.09). These results should be interpreted cautiously due to the small number of patients with complete 3-month follow-up. (4) Conclusions: Transvaginal radiofrequency ablation is an effective, precise, and safe minimally invasive approach for treating uterine fibroids. These preliminary findings are promising but require confirmation in larger cohorts with longer follow-up.

Background/Objectives: Pain assessment during hysteroscopy facilitates rapid operator intervention (e.g., repeated anesthesia, administration of additional analgesics, or termination of the procedure), thereby improving patient comfort. Traditionally, pain intensity has been evaluated based on the patient’s subjective reporting; however, the introduction of an objective indicator in combination with subjective measures can considerably improve pain assessment. In this context, the present study aimed to evaluate pain intensity in patients undergoing hysteroscopy under local anesthesia (GUBBINI Mini Hystero-Resectoscope; Tontarra Medizintechnik, Tuttlingen, Germany), with simultaneous assessment using the Visual Analog Scale (VAS) and the Analgesia Nociception Index (ANI). Determining the relationship between ANI and VAS could contribute to improving patient comfort during hysteroscopic procedures performed under local anesthesia. Methods: The study included a total of 221 patients between the ages of 22 and 82 years, divided into two groups: 125 patients underwent diagnostic hysteroscopy (HD) and 96 patients underwent operative hysteroscopy (HO). After the procedure, patients were asked to assess pain intensity by using the VAS. The ANI was also monitored during the procedure. Measurements were conducted immediately before the procedure (T0), at the 1st minute (T1), mid-procedure (T1/2), and at the end of the procedure (T2). Results: The mean pain score in the study group was 3 points (3.04 ± 2.29), with a mean post-procedure score of 2.79 ± 2.19 and 3.36 ± 2.38 in the DH and OH groups, respectively. At Tmean, the ANI values ranged from 42 to 97 points, with a mean value of 70 points (70.37 ± 10.99). All correlations between the ANI values and VAS pain scores were statistically nonsignificant (p > 0.05), with correlation coefficients close to zero. This finding indicates that subjective pain assessment (VAS) does not correspond to the ANI values, which reflects the physiological autonomic response. Conclusions: Further research on pain assessment during hysteroscopy is warranted. Future studies should include larger patient populations, conduct continuous ANI monitoring, and correlate ANI with real-time subjective pain assessments (e.g., VAS during the procedure). The determination of psychological factors, such as pre-procedural anxiety, and the use of additional autonomic nervous system measures (e.g., skin conductance and pupillometry) could facilitate the development of a comprehensive model for objective pain assessment in patients undergoing gynecological procedures through hysteroscopy.