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ObjectiveColposcopic biopsy is a discomfortable procedure. Additionally, it creates negative influence on sexuality. This studyaimed to investigate the relationships among tenaculum, pain perception, and biopsy size during colposcopy. MethodsIn total, 228 patients who underwent colposcopy-directed biopsy were included, and randomized into 4 groups basedon whether analgesic and tenaculum were used and replaced (tenaculum with n=58/without analgesic n=56, notenaculum replacement with n=57/without analgesic n=57). Lidocaine hydrochloride (40 mg) plus adrenaline (0.025mg) was administered in the analgesic groups. The pain was assessed using a linear visual analog scale. The biopsyspecimen size was measured in millimeters. ResultsThe mean age of the patients was 42.85±8.88 years. The most frequent colposcopy indications were atypicalsquamous cells of undetermined significance and human papilloma virus-positive results on cervical cytology (30.2%;n=69). Low- and high-grade intraepithelial lesions were noted in 14.91% (n=34) and 10.96% (n=25) women throughcolposcopy-directed biopsy results, respectively. Tenaculum replacement increased pain perception in the withoutanalgesic group; however, no statistically significant differences were noted between of the groups with and withouttenaculum replacement with analgesic. The size and number of biopsy specimens were not associated with tenaculumreplacement and analgesic use. ConclusionAdministration of analgesics decreased discomfortand pain in patients. Tenaculum replacement aidedcolposcopists in manipulating the cervix. Additionally,administration of analgesics relieved pain in thetenaculum replacement group.

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