الفهرس 
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Abstract
Outpatient hysteroscopy is an established diagnostic gynecological procedure that enables a clinician to visualize the uterine cavity and take endometrial biopsies or perform small intra- cavitary procedures as required. Hysteroscopy involves the use of miniaturized endoscopic equipment to examine the uterine cavity. As one of the principal investigations of abnormal uterine bleeding, hysteroscopy has an integral role in the identification of structural abnormalities of the endometrium. Outpatient hysteroscopy can also be employed for procedures such as removal of missed intrauterine devices and work‐up of reproductive problems.
Outpatient hysteroscopy is a common minimally invasive gynecological procedure that has emerged as the gold standard in the diagnosis and treatment of uterine cavity and cervical canal abnormalities both in premenopausal and post-menopausal patients who suffer from different kinds of intra-cavitary pathologies such as endometrial polyps or sub mucous myomas up to figo type 2.
The success of office endoscopic procedures may be attributed to their lower complication rate and faster patient recovery. Minor procedures performed in the outpatient setting may also decrease the need for more costly alternatives in the hospital setting.
Due to technological advances made in the last few years, diagnostic and operative hysteroscopy can be performed simultaneously in an outpatient setting, according to a “see-and-treat” principle that allows avoiding cervical dilation and anesthesia.
There are numerous advantages and disadvantages of office hysteroscopy, some of disadvantages are excessive pain, vasovagal syndrome cardiovascular events and dizziness or nausea. In general, this procedure is very safe and well tolerated by patients.
However, one of the main issues that limits conversion from a hospital setting and adoption of office hysteroscopy is the perceived pain and anxiety associated with office hysteroscopy.
Anxiety is almost always present before medical interventions and may play a role in pain perception. There seems to be a positive association between the anxiety level measured by Eysenck Personality Questionnaire (EPQ) and Taylor Manifest Anxiety Scale (TMAS), and pain measured visual analog scale (VAS), and in some cases, nervousness may lead to catastrophizing (exaggerated negative orientation toward pain stimuli). There are some validated scales widely used to measure the general anxiety level. Nonetheless, the effect of anxiety on pain perception during OH has not been well-defined yet.
This study aimed to evaluate the correlation between pre-procedural anxiety level measured by Eysenck Personality Questionnaire (EPQ) and Taylor Manifest Anxiety Scale (TMAS) and pain score during office hysteroscopy and Assessment of difficulty of office hysteroscopy.
This observational cross-sectional study was conducted on seventy-five women undergo office hysteroscopy for various gynecological indications (infertility assessment, abnormal uterine bleeding, recurrent pregnancy loss, suspect uterine anomaly, and suspect of endometrial pathology).
Summary of our results:
• Regarding personal data, mean age value was 37.47, mean parity numbers were 2, the mean abortion times was 1 and 100% of the patients have vaginoscopic method of introduction.
• Regarding office hysteroscopy procedure details, the main patients complaints were infertility, bleeding, recurrent pregnancy loss, uterine anomaly, endometrial pathology.
• Introduction of scope was easy in 92%, difficult in 607%, and failed in 1.3%.
• The mean duration of the procedure was 4.59.
• There was a statistically significant positive correlation between VAS score with difficulty of hysteroscopic procedure, with p-value (p=0.034 & p<0.001), respectively.
• There was a statistically significant association between Taylor’s manifest anxiety scale with main complain among all studied patients, with p-value (p<0.05).
• There is no statistically significant association between Eysenck personality with main complain, with p-value (p>0.05).
• There was a statistically significant difference between main complain according to VAS level with p-value (p<0.05).
• There was a highly statistically significant positive correlation between Taylor’s Manifest Anxiety Scale (TAMS) with Eysenck Personality Questionnaire, with (r-value 0.711 & p<0.001).
• Also, statistically significant positive correlation between Taylor’s Manifest Anxiety Scale (TAMS) with VAS score, with (r-value 0.304 & p=0.008).
• Eysenck Personality Questionnaire and VAS score have insignificant correlation, with p-value (p>0.05).