143 VR for pain relief in HSG 6 were only partially, or not met (Table 5). When asked an open-ended question why their expectations were not (fully) met, women stated that pain predominated the VR application, or that the installed video applications were insufficiently engaging to distract them completely. When asked what other VR applications women would have liked to see, they noted that they would have liked to watch an episode of a comedy series, other nature sceneries or short films with baby animals (kittens/puppies). Table 5. VR experiences. Total n=26* Distracted by VR (mean, SD) 3.54 (0.76) Able to concentrate (mean, SD) 3.19 (0.94) Feeling into the VR environment (mean, SD) 2.90 (1.14) Missing sound (mean, SD) 2.50 (1.30) Satisfaction with film options (%) 14 (53.8) VR expectations were met (%) Yes 15 (57.7) No 1 (3.8) Partially 10 (38.5) Full questions (range 1-5, ‘not at all’ to ‘completely/all the time’): ‘To what extend did the movie(s) distract you from the HSG?’ ‘To what extend were you able to focus on the movie(s)?’ ‘There was no sound with the movie(s). Did you miss this?’ * These questions were answered by women from the subset (n=50) that had received the VR intervention (n=26). DISCUSSION Summary of findings In this RCT the use of Virtual Reality (VR) to reduce pain during HSG was not effective. Patients in both the intervention group and control group reported similar peak pain scores and overall pain scores. In addition, no significant differences were seen in satisfaction score and amount of time spend thinking of their discomfort. Comparison to other studies In a recent RCT of 82 women, VR was applied during an operative hysteroscopy (19). Women either received VR during hysteroscopy in addition to standard care, or standard care alone. Virtual Reality did not result in significant lower pain scores during the procedure (median pain score 5.0 in both the intervention and control group, p=0.67). In contrast, an RCT of 40 women that applied VR during hysteroscopy, found a statistically significant decrease in both worst pain and average pain (mean reduction 2.2 and on a
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