Does a male operator increase the pain perception of women undergoing hysterosalpingography examination?

In this issue, Tokmak et al publish an interesting article entitled The effect of preprocedure anxiety levels on postprocedure pain scores in women undergoing hysterosalpingography. This prospective randomized study enrolled 109 women who underwent hysterosalpingography (HSG). All patients had their anxiety levels assessed and scored using the Beck anxiety inventory. The authors investigated the effect of various clinical factors and preprocedural anxiety levels on pain perception in these women after the HSG procedure and found that high preprocedure anxiety levels and male operators contributed to increased postprocedure pain in women who received HSG examination. We congratulate the authors on the success of this publication. Pain is a complicated mechanism, and not easily investigated. Many factors, for example, endocrine, the nervous system, psychosocial relationships, personality, and other elements might be interwoven into an often very subjective determination of pain level. There is no doubt that preprocedure anxiety could be partly responsible for patient personality, and the characteristics of the patient personality might be much more complicated than we expected in that it also involved genetic and environmental interactions. In the Chinese Journal of Medical Association, the same group of authors previously published a similar study and obtained similar results. The end results of their study showed that there were significantly positive correlations between preprocedural traitestat levels and procedurerelated pain [as assessed by the visual analogue scale (VAS)] during office hysteroscopy. In addition, the authors also found that in-hospital waiting time was the most important factor contributing to high VAS during office hysteroscopy, suggesting that further consideration should be devoted to improving patient care. Effectively finding avenues to decrease patient anxiety might also be a key factor in improving patient compliance and satisfaction when patients are being prepped to undergo any intensive procedure and therapy. Therefore, it would appear that all managers and/or superintendents should consider how to provide a much warmer, kinder, and more humanized environment, and a well-trained team of workers, which could impact a patient's search for health care providers. Evidence has shown that the presence of a cold and unfriendly