Effect of immersive virtual reality on fear, anxiety, and pain in pregnant women during vaginal examination in clinical training: a randomized controlled trial.

Vaginal examination is an essential component of maternal assessment during pregnancy, performed to evaluate cervical status and monitor the progress of labor. Despite its clinical importance, this procedure may provoke fear, anxiety, and pain in pregnant women. Immersive Virtual Reality has emerged as a safe, non-pharmacological intervention that enables patients to interact with a device that delivers a simulated environment during medical procedures. By creating an engaging, immersive experience, VR can divert pregnant women's attention away from the immediate clinical setting of the examination, thereby alleviating psychological distress and discomfort. This study aimed to investigate the effect of immersive VR on fear, anxiety, and pain among pregnant women during clinical training of vaginal examination. This randomized controlled trial was performed in a teaching hospital in Mashhad, Iran. (IRCT20220704055367N7). The participants of this trial were 70 pregnant women who were in the latent or active phase of labor and required vaginal examination as part of routine intrapartum care. The participants were randomly assigned to either an immersive VR intervention group (n = 35) or a standard-care control group (n = 35). The participants who were assigned to the VR group used a head-mounted display with a relaxing virtual environment during the entire vaginal examination conducted by medical trainees. The state of anxiety was assessed by using the State-Trait Anxiety Inventory (STAI) before and immediately after the vaginal examination. Pain was assessed by using the Visual Analog Scale (VAS), McGill Pain Questionnaire (MPQ), and the fear of pelvic examination checklist immediately after the vaginal examination. A total of 70 pregnant women were randomized into VR and control groups. Post-intervention analysis revealed significantly lower state anxiety in the VR group compared to controls (34.31 ± 9.07 vs. 45.66 ± 13.03; p < 0.001). Pain intensity measured by VAS was also significantly reduced in the VR group (3.43 ± 2.13 vs. 6.29 ± 2.18; p < 0.001). The McGill Pain Questionnaire showed significantly lower scores across all pain dimensions in the VR group (p < 0.05). Furthermore, fear during all stages of the vaginal examination was significantly lower in the VR group than in the control group. (p < 0.001). Immersive VR serves as an effective non-drug treatment that delivers safe patient results while maintaining high user satisfaction because it decreases fear and anxiety and pain levels during vaginal examinations conducted by trainees on pregnant women. The routine in intrapartum care and medical education for midwives will enhance maternal satisfaction and deliver high-quality clinical education.