Abstract
Introduction: Office hysteroscopy (OH) offers a "see and treat" strategy, enabling most gynecological conditions to be addressed outside the operating room without anesthesia. Despite its convenience, the associated pain and stress remain significant barriers to its widespread success among women. Both pharmacological and non-pharmacological interventions have been explored to mitigate these challenges, albeit with mixed outcomes. Methods: This study aimed to evaluate the effectiveness of virtual reality (VR) in reducing pain and stress associated with OH using objective measurements. Results: Our findings indicate that VR significantly reduced pain during OH compared to the control group (-1.08, 95%CI; -1.93-0.23, on the Visual Analogue Scale (VAS), p = 0.013) and 10 min post-procedure (-1.24, 95%CI; -1.99-0.48, p = 0.001), without significant effects on stress-related variables. Stratified analyses further revealed that the efficacy of VR in pain reduction is influenced by individual patient characteristics, with greater effectiveness observed in women with lower baseline stress, premenopausal status and a history of childbirth, regardless of vaginal delivery. Conclusions: VR represents a promising strategy for managing OH-associated pain, with its effectiveness largely depending on patient-specific variables.