Pain Control During Hysterosalpingography: a Three-Arm Randomized Trial

Hysterosalpingography is a commonly used diagnostic procedure in the evaluation ofinfertility and may cause pain during cervical manipulation, cannula or catheterplacement, cervical traction, uterine distension, and contrast injection.Participants will be randomized in a 1:1:1 ratio to one of three groups: no analgesicpremedication; a single 100 mg rectal indomethacin suppository administered 30 minutesbefore HSG; or paracervical block with 2% lidocaine hydrochloride administered at the 4and 8 o'clock positions of the cervix. The total lidocaine dose will not exceed 4.5 mg/kgor 200 mg, whichever is lower, and HSG will begin approximately 5 minutes aftercompletion of the block.Pain will be assessed using a 0‐10 Numeric Rating Scale at predefined procedural timepoints. The primary endpoint is pain during contrast injection. Additional assessmentsinclude baseline pain, pain during speculum placement, cervical manipulation, cannula orcatheter placement and cervical traction, immediate post‐procedure pain, pain 30 minutesafter HSG, rescue analgesia requirement, participant satisfaction, vasovagal symptoms,adverse events, and the most painful procedural step. Before randomization, participantswill also complete the Turkish five‐item short form of the State‐Trait Anxiety Inventory(STAIS‐5) and rate their expected HSG pain on a 0‐10 scale.