Effect of Pre-Procedural State-Trait Anxiety on Pain Perception and Discomfort in Women Undergoing Colposcopy for Cervical Cytological Abnormalities

Background: Colposcopy is the gold standard procedure for evaluating cervical cytological abnormalities.Although it is essentially a minimally invasive intervention, referral for colposcopy may cause significant distresson patients. In this study, we aimed to determine if pre-procedural anxiety levels have a significant associationwith procedure related pain and discomfort in women undergoing colposcopy for evaluation of abnormal cervicalcytology. We also assessed the impact of various clinical factors on anxiety, pain and discomfort in these patients.Materials and
Methods: This prospective study was performed at the gynecologic oncology department of ZekaiTahir Burak Women’s Health Education and Research Hospital in Ankara, Turkey between January and June2013. After taking informed consent, State-Trait Anxiety Inventory (STAI) form and a 14-item questionnairewere filled for women who were admitted to our outpatient colposcopy unit for evaluation of abnormal cervicalcytology. STAI scores were calculated for each participant. Immediately after the procedure, visual analogscale (VAS) scores for procedure-related pain and discomfort were obtained. Associations between STAI andVAS scores were investigated using correlation analyses. The effect of various contributing factors on anxiety,pain and discomfort were evaluated with linear regression analysis. The p values less than 0.05 were consideredstatistically significant.
Results: A total of 222 women met the inclusion criteria within the study period. Meanpatient age was 38.5±9.6. Median state and trait anxiety scores were 47 and 46, respectively. Median VAS scoresfor pain and discomfort were 4 for both variables. State anxiety had a significant correlation with procedurerelated discomfort (p=0.02). Colposcopy related pain VAS scores were significantly affected by state anxietylevel, marital status and prior gynecological examination (p<0.05). Colposcopy related discomfort VAS scoreswere significantly affected by state anxiety level, marital status, prior gynecological examination and educationalstatus.
Conclusions: Additional measures should be implemented in women that carry higher risk for experiencingpain and discomfort. Social, cultural and lifestyle issues may also affect women’s experiences during colposcopy,therefore further studies are needed to define specific determining factors in various populations.