Pain Management in Colposcopic Biopsy: Systematic Review and Meta-Analysis

This systematic review and meta-analysis evaluated the effectiveness of 10% lidocaine spray in reducing pain during colposcopy-directed cervical biopsy. Six electronic databases were searched through 15 November 2025, and randomized controlled trials reporting biopsy-related pain outcomes were included. Eight studies met the criteria for qualitative synthesis, and four provided sufficient data for quantitative analysis. Data extraction and risk-of-bias assessment were conducted independently by two reviewers following PRISMA 2020 standards. Standardized mean differences (Hedges g) were pooled using a random-effects model. The included trials demonstrated considerable variability in sample size, comparator groups, and procedural methods. Three studies comparing lidocaine spray with placebo, saline, or no anesthesia showed minimal or no analgesic advantage, whereas one trial comparing lidocaine with forced coughing demonstrated a significant reduction in biopsy pain. The pooled analysis indicated a small but statistically significant effect favoring lidocaine spray (SMD = –0.29, 95% CI –0.56 to –0.02), although substantial heterogeneity was present (I² = 68%). Overall, lidocaine spray appears to offer only modest analgesic benefit, likely limited by low baseline pain levels and methodological variability across trials. Despite its non-invasive and practical profile, clinicians should recognize its limited clinical impact and consider multimodal strategies for optimizing patient comfort during colposcopy. Further large-scale, standardized randomized trials are needed to identify patient subgroups most likely to benefit from topical anesthetics.