Colonoscopy and Anxiety: How Virtual Reality Eliminates Fear

The exam that saves lives but everyone puts off

Colonoscopy is the most effective tool for preventing colorectal cancer — the second deadliest cancer in Italy. Yet a significant portion of the population puts it off or avoids it altogether.

The reason is almost never medical. It's emotional.

Fear of pain. Embarrassment. A sense of vulnerability. The feeling of losing control over one's own body. Those who have had an unpleasant colonoscopy the first time often do not return for follow-up, even when the doctor recommends it.

The sedation problem

The standard solution is sedation: the patient falls asleep, feels nothing, wakes up, and goes home. It works.

But it has costs:

An anesthesiologist is needed
The patient must remain under observation for 30-60 minutes afterward
Not all centers have the resources to sedate every patient
Some patients cannot be sedated for clinical reasons
The patient loses an entire morning

The third way: present but elsewhere

Immersive therapy offers a third option between "you feel everything" and "you feel nothing because you're asleep".

The patient remains awake, present, and cooperative. But their attention is elsewhere. They are immersed in an environment that their brain processes as real: a mountain landscape, a beach at sunset, a path through a forest.

They are not sedated. They are not "distracted" in the trivial sense of the word. They are cognitively engaged in an experience that leaves little room for signals of discomfort.

What the studies say

RCT 2025 — Colonoscopy VR vs intravenous sedation:

A randomized controlled study directly compared immersive VR with deep sedation during colonoscopy. The results: comparable levels of pain and anxiety between the two groups. But the VR group did not need post-procedural recovery.

BMJ Open 2025 — VR meta-analysis and colonoscopy:

Registered protocol for a systematic review of all RCTs on VR during colonoscopy. The fact that BMJ Open is publishing the protocol indicates how relevant the scientific community considers the topic.

2025 Tunisian study (Health Science Reports):

Immersive VR during outpatient colonoscopy without sedation:

Significant reduction in perceived pain
Reduction in anxiety
Greater patient satisfaction
No adverse events

It's not just pain: it's dignity

There's an aspect of colonoscopy that is rarely discussed: vulnerability. The patient is in an exposed position during an intimate procedure, surrounded by healthcare staff.

VR doesn't just eliminate physical pain. It eliminates the constant awareness of one's position, of one's exposed body. The patient is mentally elsewhere — and that "elsewhere" gives them a degree of inner privacy that sedation alone does not always guarantee.

For the endoscopist: a cooperative patient

A relaxed patient is a patient who does not tense up. Relaxed abdominal muscles make the procedure technically simpler. The endoscope advances with less resistance. Procedure time is reduced.

Who chooses VR instead of sedation

Not all patients will want VR. But for many it is the preferable option:

Those who need to return to work right after
Those who cannot be sedated (comorbidities, allergies, frail elderly patients)
Those who want to drive themselves home
Those who prefer to stay awake and present
Those who have had negative experiences with sedation

VR does not replace sedation — it complements it. It adds an option where there were previously only two choices: endure it or sleep.

Changing the colonoscopy narrative

Colonoscopy has an image problem. It's the exam that "everyone knows they should get" but that "no one wants to get." The result: late diagnoses, cancers that could have been prevented.

If the colonoscopy experience changes — if it becomes something manageable, non-traumatic — the narrative changes too. People who have a neutral or positive experience talk about it. They recommend the exam to others.

Prevention only works if people show up. Immersive therapy makes showing up easier.