Abstract STUDY OBJECTIVE: Fluid minihysteroscopy is in most cases a painless procedure. However, rarely, severe pain and side effects are reported. The goal of this study was to identify predictive factors of pain at minihysteroscopy. DESIGN: Prospective study (Canadian Task Force classification II-2). SETTING: Academic environment. PATIENTS: Five hundred thirty-three women undergoing fluid minihysteroscopy. INTERVENTIONS: Diagnostic fluid minihysteroscopy. MEASUREMENTS AND MAIN RESULTS: The women were asked to score pain perception on a visual analog scale from zero (no pain) to 5 (unbearable pain). Correlation between pain at procedure and parity, previous cesarean section (PCS), menopausal status, anxiety, and chronic pelvic pain (CPP) was evaluated. Four hundred thirteen women (78%) reported no pain or discomfort (0-1 pain score, group A), while 120 (22%) experienced mild to unbearable pain (2-5 pain score, group B). Instances of PCS, CPP, anxiety, and menopause were significantly lower in group A than in group B (4% vs 82%, 0% vs 29%, 62% vs 72%, 25% vs 72%, respectively), whereas menopausal status was less frequent in group A (25.2%) than in group B (72.5%). At binary logistic regression, all the variables were independent risk factors for pain; however, when CPP was stratified for intensity, no correlation between pain at procedure and intensity of CPP was found. CONCLUSION: Previous cesarean section, CPP, anxiety, and menopause are predictive factors for pain perception during fluid minihysteroscopy, and history of CPP even of low intensity is predictive of pain at hysteroscopy. These patients may benefit from local anesthesia.