One of the most important aspect of surgical intervention is pain control, to ensure the procedure can be completed with minimal or no distress to the patients. Analgesia that had be used in MVA include oral, rectal or parenteral analgesia, intracervical analgesia, paracervical block, Entonox, oral and parenteral opiod or combination of these techniques. 5-11 All these methods had been shown to be effective in providing pain relieve during MVA, but the factors that may contribute to the pain sensation had not been adequately addressed. Here we are discussing the pain perception of our patients during MVA and the associated factor. ABSTRACTBackground: Manual vacuum aspiration (MVA) is an alternative to the standard sharp uterine curettage, performed under local anaesthetic or sedation in the daycare setting. The objectives of this study were to assess the efficacy and safety of MVA, the pain perception and the factors related to it. Methods: This was a prospective observational study of 58 consecutive patients who had undergone Manual Vacuum Aspiration (MVA) in Early Pregnancy Assessment Clinic, Hospital Kemaman between January and December 2017. Data on the patients' characteristics and the procedures were analysed. Results: The efficacy of the procedure was 96.5% (56/58) with no major complication recorded. Majority of the patients (91.3%) reported mild to moderate pain with 2/3 of them agreed to undergo MVA in the future and would recommend it to other patients. There was no significant difference in mean pain score between different groups of women (parity, education levels, occupations, previous uterine evacuation) or procedural techniques (analgesia, sedation, cervical block, cervical dilatation, procedure duration, number of aspiration passes). Conclusions: MVA is safe and well accepted procedure for out-patient surgical evacuation of early miscarriages.