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Use of a Simple Visual Distraction to Reduce Pain and Anxiety in Patients Undergoing Colposcopy

Carwile, Jenny L. ScD, MPH1; Feldman, Sarah MD, MPH2; Johnson, Natasha R. MD3

Journal of Lower Genital Tract Disease: October 2014 - Volume 18 - Issue 4 - p 317–321
doi: 10.1097/LGT.0000000000000024
Original Articles

Objective: We hypothesized that a passive visual distraction would reduce pain and anxiety among women undergoing colposcopy.

Materials and Methods: We assessed the association between exposure to a passive visual distraction during colposcopy and procedure-related pain and anxiety using a nonrandomized intervention design. Women presenting for initial or repeat colposcopy at Brigham and Women’s Hospital Colposcopy Clinics were eligible for participation. Women undergoing colposcopy during the first 6 months of the study (n = 168) were not exposed to the visual distraction, whereas women undergoing colposcopy during the second 6 months of the study (n = 153) were exposed to a pleasing, passive visual distraction consisting of images on a light diffuser installed within the examination room’s ceiling light. We used ordinal logistic regression to compare self-reported pain, measured using the visual analog scale, and anxiety, measured using the Spielberger State-Trait Anxiety Inventory-6, among women receiving and not receiving the intervention.

Results: Two hundred sixteen women with complete data were included in the final analyses. Women in both groups reported high levels of colposcopy-related anxiety. Compared to women who did not receive the visual distraction, women receiving the visual distraction during colposcopy had a 54% reduction in the odds of experiencing a given level of postexamination pain, holding preprocedure pain constant (odds ratio = 0.46, 95% confidence interval = 0.28–0.77). Visual distraction was not associated with postexamination anxiety (odds ratio = 0.95, 95% confidence interval = 0.60–1.51).

Conclusions: A passive visual distraction reduced perceived pain, but not anxiety, after colposcopy.

Exposure to a passive visual distraction during colposcopy reduced perceived postprocedure pain, but not anxiety, in a nonrandomized intervention.

1Department of Epidemiology, Harvard School of Public Health; and Divisions of 2Gynecological Oncology and 3General Gynecology, Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women’s Hospital, Boston, MA

Reprint requests to: Natasha R. Johnson, MD, Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115. E-mail:

This study was supported by Expanding the Boundaries, Brigham and Women’s Hospital, Department of Obstetrics and Gynecology institutional grant. J.L.C. was supported by Training Grant T32 ES 007069 in Environmental Epidemiology, National Institute for Environmental Health Sciences, National Institutes of Health, and Training Grant T32HD060454 in Reproductive, Perinatal and Pediatric Epidemiology from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health.

The authors have declared they have no conflicts of interest.

Copyright © 2014 by the American Society for Colposcopy and Cervical Pathology