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Objective: To compare the clinical results of utilizing a combination of oral diclofenac potassium and vaginal dinoprostone for pain management during hysterosalpingography (HSG) versus using only oral diclofenac potassium. Material and Methods: From September 2020 to September 2021, researchers at Aswan University Hospital conducted a randomized controlled trial. Reproductive-aged infertile women who were scheduled for HSG were administered diclofenac plus vaginal dinoprostone or diclofenac plus placebo to vaginal dinoprostone. All women were given vaginal dinoprostone or placebo six hours before the surgery, which was applied to the upper vagina by the patient, followed by oral 50 mg diclofenac potassium tablets one hour before HSG. The participants' self-rated pain experience was measured using a 10-cm Visual Analogue Scale (VAS) during speculum installation, cervical tenaculum implantation, dye injection, and 5 and 30 minutes after the operation. Results: Two hundred women were enrolled (n = 100 in each group). Oral diclofenac plus vaginal dinoprostone significantly reduces the main VAS pain scores during injection of the dye (4.18 ± 0.90 vs. 6.23 ± 0.89), 5 min postprocedure (3.81 ± 0.91 vs. 5.05 ± 0.95) and 30 min post-procedure (2.69 ± 0.80 vs. 4.14 ± 0.74) with p < 0.01 at all steps. There were no significant variations in VAS scores after using a speculum or tenaculum. Conclusion: Utility of adjuvant vaginal dinoprostone six hours before HSG to oral diclofenac potassium one hour before HSG significantly more effective than diclofenac potassium for alleviate the induced pain during and 30 min after the HSG procedure.

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