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STUDY OBJECTIVE To assess how the location of intracavitary lesions during office hysteroscopy influences pain scores. DESIGN Cohort study. SETTING Department of Obstetrics and Gynecology, Hospital das Forças Armadas, Lisbon, Portugal. PATIENTS Two hundred ninety-eight patients undergoing operative office hysteroscopy. INTERVENTIONS Pain intensity was assessed by patients using a numeric rating scale (0-10) 10 minutes after hysteroscopy. MEASUREMENTS AND MAIN RESULTS Statistical analysis assessed the association between pain score and clinical, obstetric, and gynecologic history. Associations with procedure-related factors were also assessed. Lesion location did not influence the perception of pain in the current sample. Hysteroscopic anesthesia allowed for a significant reduction in pain scores, regardless of lesion location. Multivariate analysis revealed that only the type of operative procedure and operating time significantly influenced pain scores. CONCLUSION Hysteroscopic anesthesia allows for a well-tolerated procedure, regardless of lesion location during office hysteroscopy. Lesion location should not be regarded as a technical limitation.