Hundreds of women left ‘distressed’ by diagnostic test

Around 520 women who attended NHS hospitals in England to undergo hysteroscopies — a procedure which uses narrow telescopes to examine the womb to diagnose the cause of heavy or abnormal bleeding — have told a survey their doctors carried on with their procedures even when they were in severe pain.

This is despite the Royal College of Obstetricians and Gynaecologists advising clinicians should offer to reschedule with the use of general anaesthetic, epidural or sedation if the pain becomes unbearable. 

The Campaign Against Painful Hysteroscopy patient group has surveyed 860 women who had had the procedure at an English NHS hospital, and shared the results with HSJ. Of them, 750 said they were left distressed, tearful or shaken by the procedure, with around 466 of them saying that feeling remained for longer than a day.

Many of the women said their painful hysteroscopies damaged their trust in healthcare professionals, had made cervical smears more painful and had a negative impact on sexual relationships.

The survey also found 660 of the women were not made aware the procedure could be done under general anaesthetic, epidural or sedation, raising concerns hospitals are not giving women appropriate information.

Some of the women surveyed likened their hysteroscopies to “torture” and described doctors carrying on with the procedure even though they were screaming in pain.

‘It must be stopped’

RCOG called the survey findings “very concern[ing]”, adding all pain relief options should be discussed with hysteroscopy patients, as well as the risks and benefits of each. 

It added that, while hysteroscopies are a quick and safe procedure which the majority of women do not find particularly painful or uncomfortable, it can be a very painful procedure for some women. 

RCOG president Edward Morris said: “We are very concerned by reports of women going through painful and distressing hysteroscopy procedures. Pain relief options should be offered to every woman before and during the procedure, to make the experience as comfortable as possible.

“Women should be given the choice of a local or general anaesthetic. If the procedure is still too painful, no matter what anaesthetic options are chosen, it must be stopped. A further discussion of pain relief options should take place and a woman’s choice must always be fully supported.”

Meanwhile, the British Society for Gynaecological Endoscopy has previously said: “Diagnostic hysteroscopy is a commonly performed investigation; it is safe and of short duration.  Most women are able to have the procedure in an outpatient setting, with or without local anaesthesia, and find it convenient and acceptable. 

“However, it is important that women are offered, from the outset, the choice of having the procedure performed as a day case procedure under general or regional anaesthetic. Some centres are also able to offer a conscious sedation service in a safe and monitored environment.

“It is important that the procedure is stopped if a woman finds the outpatient experience too painful for it to be continued.  This may be at the request of the patient or nursing staff in attendance, or at the discretion of the clinician performing the investigation.”

‘Driven by a wilful blindness’ 

The Campaign Against Painful Hysteroscopy is now calling for the current best practice tariff, which rewards trusts for doing at least 70 per cent diagnostic hysteroscopies in outpatients, to be scrapped, and for screaming and sobbing in gynaecology clinics to be a patient safety never event.

A campaign spokeswoman said: “Our survey documents women coerced into completing distressing hysteroscopies or biopsies in order to know if they have cancer. Traumatised patients subsequently require counselling and even refuse potentially lifesaving gynae tests.

“There is a total underresourcing of expert anaesthesia for hysteroscopy driven by a wilful blindness to the existence or consequences of pain-receptors in the cervical canal and endometrium.”