Aim of the work: this work aimed to assess the analgesic efficacy of lidocaine dissolved in the distension medium compared to oral diclofenac before outpatient diagnostic hysteroscopy Patients and methods: this randomized controlled trial included 44 nulliparous women schedules to undergo diagnostic office hysteroscopy. The participants were randomly categorized into two groups; group D (n=22) received diclofenac 100 mg oral tablets and group L (n=22) received 10 ml of lidocaine 2% dissolved in saline (The distension medium). Pain was evaluated during hysteroscope insertion and 5, 10, 15 and 30 minutes after using visual analog scale (VAS). The patient was considered in pain if the VAS score was ≥ 4. Results: hysteroscope insertion was associated with pain in 35 patients (79.5%); more frequently in group L (p = 0.021). Severe pain was reported by 13 patients (29.5%); more in group L (p = 0.099). All patients were pain-free 15 minutes after procedure start. Group L showed significantly higher pain scores with hysteroscopic insertion (p = 0.017). The two groups had comparable pain scores 5, 10 and 15 minutes from the procedure start. Few adverse reactions were recorded. The two drugs were hemodynamically stable. Conclusion: oral treatment with 100 mg diclofenac one hour before office hysteroscopy was a safe and more effective in pain control during the procedure compared to lidocaine dissolved in saline used as the distension medium.