Virtual reality and podcasts reduce anxiety and pain during colposcopy in randomized trial

PURPOSE: Colposcopy-related anxiety affects up to 80% of women, increasing pain perception and reducing satisfaction. Virtual reality has shown promise, but few studies have compared it with other active distraction methods during colposcopy. This three-arm randomized controlled trial evaluated the effectiveness of virtual reality versus podcast versus standard care in reducing anxiety and pain during colposcopy. METHODS: Between March and June 2025, 90 women undergoing colposcopy at a tertiary gynecologic oncology center in Turkey were randomized equally to virtual reality, podcast, or standard care. Interventions began 5 min before and continued throughout the procedure. The primary outcome was change in State-Trait Anxiety Inventory scores; secondary outcomes included Visual Analog Scale pain scores, patient satisfaction, Perceived Stress Scale scores, and 24-h analgesic use. RESULTS: Ninety participants were randomized (96.7% completion rate). In intention-to-treat analysis, both interventions reduced anxiety significantly compared with control (State-Trait Anxiety Inventory change: virtual reality -7.9, podcast -10.5, control + 6.5; p < 0.001). Virtual reality provided the strongest analgesic benefit (Visual Analog Scale 1.7 vs. 3.0 with podcast and 4.3 with control; p < 0.001) and the highest satisfaction (9.4 vs. 7.9 vs. 4.2; p < 0.001). Analgesic use was lower in the virtual reality (46.4%) and podcast (55.2%) groups compared with control (76.7%; p = 0.047). Perceived Stress Scale scores and physiological measures showed no group differences. Two participants in the virtual reality group experienced mild, self-limiting adverse effects. CONCLUSIONS: Both virtual reality and podcasts significantly reduced colposcopy-related anxiety, with virtual reality providing superior pain control and satisfaction. Podcasts, as a rarely studied spoken-word distraction modality, represent a practical, low-cost alternative. These findings support integrating distraction-based strategies to improve patient experience during colposcopy.