Reducing pain and anxiety with virtual reality in (outpatient) gynecological procedures: a systematic review with meta-analysis

Background Virtual Reality (VR) is increasingly used in medicine for pain and anxiety management. It has been frequently studied in the field of Gynecology and Obstetrics and found effective during labour. However, its application during (outpatient) gynecological procedures as pain and anxiety management remains underexplored. Objective This systematic review with meta-analysis aimed to study the effect of VR on pain, anxiety and patient experiences when provided during (outpatient) gynecological procedures. Study design A systematic review was performed, by systematically searching PubMed, Embase, APA PsycInfo and Web of Science (Core Collection) from inception to March 20th 2024. Articles on the effect of VR on pain (VAS or NRS) and anxiety (all measurement tools) during (outpatient) gynecological procedures were included. Study designs had to be randomized controlled trials (RCTs) or cohort studies. Data were collected independently by two reviewers. A meta-analysis was performed to calculate mean differences (MD) with 95% Confidence Intervals (95%CI), Sensitivity analyses and a subgroup analysis were performed. Results Thirteen RCTs, published between 2015 and 2024, reporting on VR during (outpatient) gynecological procedures for benign conditions were included. Virtual Reality significantly improved overall pain scores (MD -0.95 (95%CI -1.44 to -0.47); n=12, I 2 =77%; scale 0−10), preprocedural anxiety (MD -3.33 (95%CI -5.84 to -0.82); n=5, I 2 =5%; scale 0−100) and postprocedural anxiety (MD-15.83 (95%CI -29.39 to -2.17); n=6, I 2 =93%; scale0−100). Conclusion The meta-analysis suggests that VR could positively influence overall pain and procedural anxiety. Not all studies reported on all outcome measures which might have introduced reporting bias and lead to an overestimation of the effect of VR. Future studies should further study the correlation between pain and anxiety and the effect of VR on this. However, VR provides an alternative to pain medication, without the risks associated with pharmaceuticals, making it an attractive option.