Pain Control for Outpatient Colposcopy, Loop Electrode Excision Procedure, Vulvar Biopsy, and Endometrial Biopsy

Authors

• Mary M. Hillard, From the George Washington University School of Medicine and Health Sciences, Washington, DC.
• Allison K. Etcheverry, From the George Washington University School of Medicine and Health Sciences, Washington, DC.
• Gabrielle E. Smotrich, From the George Washington University School of Medicine and Health Sciences, Washington, DC.
• Joey Bahng, George Washington Medical Faculty Associates, Sexual Health and Gender Affirmation Center, Washington, DC.
• Kathryn Dumas, George Washington Medical Faculty Associates, Sexual Health and Gender Affirmation Center, Washington, DC.
• Anita Mikkilineni, George Washington Medical Faculty Associates, Sexual Health and Gender Affirmation Center, Washington, DC.
• Sarah T. Cigna, George Washington Medical Faculty Associates, Sexual Health and Gender Affirmation Center, Washington, DC.

Document Type

Journal Article

Publication Date

4-3-2026

Journal

Journal of lower genital tract disease

DOI

10.1097/LGT.0000000000000945

Keywords

anesthetic; colposcopy; endometrial biopsy; loop electrical excision procedure; pain control; vulvar biopsy

Abstract

OBJECTIVES/PURPOSES OF THE STUDY: Outpatient gynecologic biopsies elicit discomfort that negatively impacts patient satisfaction and limits the ability to obtain adequate sampling. We examined relevant studies focusing on colposcopy, loop electrode excision procedure, endometrial biopsies, or vulvar biopsies. MATERIALS AND METHODS: This systematic review conducted a search in PubMed, ClinicalTrials.gov, Embase, and Scopus databases following PRISMA Guidelines. Two reviewers independently extracted data from each study with Covidence software. Exclusion criteria included articles published before 2015, procedures done in inpatient hospital settings, and obstetric procedures. Studies were categorized by procedure type and compared by the primary data point of reduction in pain score during biopsy. RESULTS: Of 8388 publications screened, 20 colposcopy and LEEP studies, 14 EMB studies, and 3 vulvar biopsy studies were included in the final review. The primary outcome measured across studies was pain score at the time of biopsy. CONCLUSIONS: Lidocaine spray, IUL, PCB, and oral NSAIDs were found to be effective pain control options during EMB. Vulvar biopsy is largely unstudied, but the procedure induces significant changes in VAS scores as compared with patient baselines. For colposcopy and LEEP, local anesthetic with injection of lidocaine is superior to nonpharmacologic interventions such as music. Lidocaine spray remains a better alternative than no pain intervention. Patient preference, while variable, is an important factor to consider when choosing an anesthetic intervention.

APA Citation

Hillard, Mary M.; Etcheverry, Allison K.; Smotrich, Gabrielle E.; Bahng, Joey; Dumas, Kathryn; Mikkilineni, Anita; and Cigna, Sarah T., "Pain Control for Outpatient Colposcopy, Loop Electrode Excision Procedure, Vulvar Biopsy, and Endometrial Biopsy" (2026). GW Authored Works. Paper 9124.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/9124

Department

Obstetrics and Gynecology