The use of Pre-operative Virtual Reality to Reduce Anxiety in Women Undergoing Gynecological Surgeries

A Prospective Cohort Study

Jason Ju In Chan; Cheng Teng Yeam; Hwei Min Kee; Chin Wen Tan; Rehena Sultana; Alex Tiong Heng Sia; Ban Leong Sng


BMC Anesthesiol. 2020;20(261) 

In This Article


Anxiety can be defined as emotions of fear, tension or unease and is often encountered before surgery.[1,2] Pre-operative anxiety has been shown to be correlated with acute and chronic post-surgical pain, increased use of post-operative analgesia and post-operative nausea and vomiting.[3–5] It also has significant impact on recovery, including longer post-operative hospital stay and even cognitive and behavioral ramifications.[2–5] Furthermore, women often experiencing higher levels of pre-operative anxiety compared to men.[2,6,7] While pharmacological interventions for pre-operative anxiety are available, reservations such as safety profile and cost often hinder physicians to fully utilize them. Therefore, non-pharmacological methods such as music and Virtual Reality (VR) are gradually growing in popularity to improve the overall patient surgical experience.[8–12]

The use of VR therapy in various clinical settings is well documented, such as physical rehabilitation, pain distraction, overcoming phobias, anxiety disorders, and post-traumatic stress disorder (PTSD).[13,14] It is reported that VR therapy results in significantly reduced anxiety, persistent pain intensity, faster wound healing, and improved neurorehabilitation outcomes in patients with burns and complex regional pain syndrome.[15,16] The technology usually consists of an audio system (earphones or headphones), a visual system (head-mounted displays) and an integrated set up (motion tracking systems). By providing multiple stimuli to the human senses, VR systems are able to allow the user an immersive experience and presence in the virtual world.[17–19]

In the gynecological population, limited evidence has been reported on the use of VR therapy for postoperative care and management. In a non-randomized controlled study recruiting patients undergoing colposcopy (cervical examination), Vasquez et al. showed that patients assigned to VR group reported reduced pain scores post-VR intervention.[20] Another prospective randomized controlled trial in an outpatient hysteroscopy setting showed that the use of VR during the procedure resulted in significantly decreased average pain score and anxiety when compared to controls.[21] Nevertheless, there are limited studies conducted in a gynecological population, and no formal sample size calculations were performed to study the expected clinical effect size related to pre-operative anxiety.

In view of the potential clinical benefits of VR, our study aimed to assess pre-operative anxiety (primary outcome) and self-reported satisfaction of VR and health state (secondary outcomes) in women undergoing minor gynecological procedures.