Pain During and After Saline–Air Hysterosalpingo-Contrast Sonography: Associations with Tubal Patency and Procedure-Related Factors

Background/Objectives: Pain during hysterosalpingo-contrast sonography (HyCoSy) varies, and associated factors remain unclear. We assessed recalled intraprocedural and first-24 h pain after saline–air HyCoSy and examined associations with tubal patency and clinical and procedural factors. Methods: We retrospectively analyzed data from 174 consecutive women undergoing saline–air HyCoSy at General Hospital Pula between August 2016 and March 2022. At follow-up 2–4 weeks later, 149 women rated intraprocedural and first-24 h pain using a 0–10 visual analog scale (VAS). Results: Bilateral patency, unilateral patency, and bilateral occlusion occurred in 131/174 (75.3%), 20/174 (11.5%), and 23/174 women (13.2%), respectively. Among women with pain data, the median intraprocedural VAS score was 5 (IQR, 3–7), and 45/149 (30.2%) reported severe pain. The median first-24 h postprocedural VAS score was 0 (IQR, 0–1). Pain categories differed by tubal patency (p = 0.0351). Higher intraprocedural pain was associated with younger age, no previous birth at or beyond 22 weeks, difficult catheter entry, resistance during contrast administration, and higher postprocedural pain. Conclusions: Saline–air HyCoSy was associated with moderate recalled intraprocedural pain and low recalled first-24 h pain. Severe pain was more frequent with unilateral or bilateral occlusion. These findings may inform counseling but require cautious interpretation because of retrospective assessment, incomplete follow-up, and univariable analyses.