\n<\/p>\n
In February this year, Beth Harris sat in the day surgery waiting room of her local hospital and tried to steady her nerves.<\/p>\n
She was there for a hysteroscopy, in this case to remove a fibroid. A thin surgical instrument with a lens, a light, a blade and an irrigation system for pumping saline solution would be inserted through her vagina and cervix, into her womb. The saline solution would widen the womb and the fibroid would be shaved away. Her hospital had advised taking paracetamol or ibuprofen an hour before the appointment, which Harris had done. However, the appointment was for 1pm, and by 4pm, she was still waiting in her hospital gown, surrounded by other patients.<\/p>\n
Hysteroscopies are common procedures \u2013 classed by the NHS as \u201chigh volume low complexity\u201d. In 2021, 71,000 took place in England alone. This was Harris\u2019s third. \u201cI\u2019d been shocked by how painful the first two were,\u201d she says. They had been \u201cdiagnostic\u201d only \u2013 examinations of the inside of the womb \u2013 because years of breast cancer medication had led her womb lining to thicken. When she learned that she had a fibroid that needed removing, Harris\u2019s first question was: \u201cWill it be painful?\u201d Her gynaecologist assured her that she would be given local anaesthetic and \u201cwouldn\u2019t feel anything\u201d. He compared it to \u201cgoing to the dentist\u201d.<\/p>\n
Any doubts Harris harboured while awaiting that procedure were multiplied by the two patients treated ahead of her. \u201cThe first woman was hysterical when she came out,\u201d she says. \u201cThe nurse had to get the consultant to talk to her. The second collapsed in the recovery room. Nobody came to her, so a little old man in his gown and slippers, a random patient, got involved and found a nurse. They took her away on a trolley.\u201d<\/p>\n
<\/span>\u2018It feels as if someone is sweeping a knife around inside you,\u2019 said one patient.<\/span> Photograph: Posed by model; Twenty47studio\/Getty Images<\/p>\n When Harris was finally called in, there were several people in the theatre. \u201cThere was the gynaecologist, nurses, an anaesthetist behind me, although he didn\u2019t do anything. They were talking to each other throughout \u2013 no one was sitting with me. It was very casual.\u201d The gynaecologist administered local anaesthetic \u2013 a small injection near the cervix \u2013 but there was no pause to see if it had worked. \u201cThere was no gap, no questions,\u201d she says. \u201cThe injection itself was painful, but the procedure, with this spinning blade inside you, was unbelievable. The pressure, the pushing of the machine, the manipulation \u2013 it was barbaric. I\u2019ve never experienced anything like it in my life. I felt as if I\u2019d been assaulted. By the end, I was crying my eyes out.\u201d A nurse led her, sobbing, to the recovery room. \u201cThere was no dignity, no privacy,\u201d says Harris. \u201cI said to her: \u2018There must be a better way of doing this.\u2019\u201d<\/p>\n Katharine Tylko, a founder member of the campaign group Hysteroscopy Action (HA), has been saying the same thing for 16 years. HA was formed in 2010 to demand that all hysteroscopy patients are fully informed about the procedure, including the risk of severe pain, and given a full range of pain relief choices \u2013 local anaesthesia, gas and air, conscious sedation, epidural, and, for those who need it, general anaesthetic. \u201cIn short, we want parity with colonoscopy patients, half of whom are men,\u201d says Tylko. In April, the renewed Women\u2019s Health Strategy set out by the then health secretary Wes Streeting seemed a major breakthrough. Action 7 of the strategy called for informed consent and a choice of pain relief for hysteroscopies. \u201cWe were thrilled,\u201d says Tylko, \u201cbut there\u2019s been nothing since. Just silence.\u201d<\/p>\n Many conditions might require a hysteroscopy. By far the most common is heavy or unexplained bleeding. In 2018, guidelines from the National Institute for Health and Care Excellence <\/strong>made them the primary diagnostic tool for this. A hysteroscopy\u2019s \u201cinside view\u201d of the womb makes them the gold standard for ruling out any sinister pathology such as endometrial cancer. They are also used to investigate cases of unexplained infertility or recurrent miscarriage, to remove uterine fibroids, polyps or scar tissue.<\/p>\n Once hysteroscopies required a general anaesthetic, but this changed through the 2000s and 2010s after clinical audits and trials established that outpatient hysteroscopies were safe, much faster and more cost-effective. (Present NHS targets are that 90% of diagnostic and 50% of operative hysteroscopies take place in an outpatient setting.) Pain relief options vary wildly across the country. Too often, says Tylko, there is nothing beyond a nurse to hold your hand and supply a constant stream of \u201chairdresser chitchat\u201d.<\/p>\n Tylko, 71, a musician and translator, required a hysteroscopy 23 years ago, because of unexplained bleeding. \u201cIt was late-stage womb cancer which took two years to be diagnosed,\u201d she says. \u201cBy then, I was bleeding so much, I was sleeping on bath towels.\u201d After numerous GP appointments, Tylko asked why she wasn\u2019t being referred for investigation. \u201cMy GP told me that I would \u2018freak out\u2019 at an NHS gynae clinic,\u201d says Tylko. The GP had reached this conclusion partly because Tylko hadn\u2019t had a baby, so her cervical canal had not been stretched, and also because she found smear tests difficult (she now knows this was almost certainly because of undiagnosed endometriosis).<\/p>\n <\/span>\u2018There was no dignity, no privacy,\u2019 said a patient.<\/span> Photograph: Posed by model; SDI Productions\/Getty Images<\/p>\n \u201cThat night was probably the worst night of my life,\u201d says Tylko. \u201cI thought: \u2018She thinks I\u2019ve got something \u2013 and she thinks I probably won\u2019t be able to stand the test for it.\u2019 I went privately and still had to jump through lots more hoops, but I finally got a hysteroscopy under general anaesthetic.\u201d<\/p>\n Through her subsequent cancer treatment, Tylko met many women who had been traumatised by their hysteroscopies. \u201cI\u2019d been told that only 2% of women had problems with them,\u201d she says. \u201cI was given the message that if I was \u2018normal\u2019, if I\u2019d had children, I wouldn\u2019t be complaining. Then I met women who\u2019d had children with no pain relief but who\u2019d fainted after their hysteroscopies.\u201d The penny finally dropped that she wasn\u2019t the only one who struggled with gynecological procedures.<\/p>\n More than 13,000 women have completed HA\u2019s online survey, which set out to learn more from women\u2019s experiences, and its petition is nearing 70,000 signatures. The comments make harrowing reading. In 2020, a benchmark multicentre study found that mean pain scores for outpatient hysteroscopies were 5.2 (that\u2019s \u201cmoderate\u201d on a hospital ward and would merit codeine) and 35% of women had a \u201csevere\u201d pain score of seven and above.<\/p>\n \u201cAs a campaign, we\u2019ve had real difficulty treading a rational path between trying to effect change but not putting women off something that can predict cancer,\u201d says Tylko. \u201cWe\u2019ve always put the caveat that two-thirds of women do not experience severe pain.\u201d Equally though, outpatient hysteroscopies have a failure rate of around 10%, with pain as the predominant reason, points out Richard Harrison, lecturer and co-lead of pain research at Reading University. \u201cThat, too, can lead to a whole lack of engagement with future medical procedures, which could be lifesaving.\u201d<\/p>\n Harrison worked on a recently published study that analysed data from nearly 5,000 women who had undergone hysteroscopies. For Harrison and his co-authors, the issue sits within a wider body of research on the gender pain gap \u2013 it\u2019s already well established that women presenting in health care settings with pain are prescribed less analgesic than men, and are more likely to be given antidepressants instead. In this hysteroscopy study, they identified a \u201cgynaecological pain gaslighting\u201d where women were repeatedly told: \u201cIt can\u2019t be that bad\u201d and: \u201cMost women tolerate this procedure well.\u201d<\/p>\n Helen Garnett, 56, from North Lincolnshire, was so certain that she would be \u201cgaslit\u201d that she secretly recorded her outpatient hysteroscopy and later released it online (with voices altered). \u201cI\u2019d already had two hysteroscopies for heavy bleeding which had been so horrendous, I\u2019d almost passed out,\u201d she says. This time, she called her GP and clinic in advance to request pain relief \u2013 and was told her consultant would discuss it on the day. The recording is excruciating to hear. Garnett is nervous, clearly but apologetically asking for pain relief \u2013 \u201cI\u2019m not wimpy but this I find so painful\u201d \u2013 but is swept through with none. Instead she was left with patronising chatter from nurses: \u201cDo you think we should have some music in here? I could sing to you!\u201d; \u201cYou\u2019re doing amazing!\u201d; \u201cWell done you!\u201d<\/p>\n \u201cIt feels as if someone is sweeping a knife around inside you,\u201d says Garnett. \u201cI have three daughters, I run my own business, I thought I\u2019d be able to advocate for myself more, but I just couldn\u2019t. It\u2019s crazy. You lose all sense of being an adult as they treat you in such a childlike manner. I\u2019m surprised they don\u2019t give you sweets and a sticker on the way out. As soon as I got away, I burst into tears. I didn\u2019t want them to see me crying like a baby.\u201d<\/p>\n Some gynaecologists are determined to make changes. Dr Gail Busby, a consultant gynaecologist for 26 years, admits it has been a \u201clearning curve\u201d. \u201cA long time ago, I don\u2019t think we were aware how painful an outpatient hysteroscopy can be,\u201d she says. \u201cAs a gynaecologist, you\u2019re so focused on the procedure. We thought it was period-like, crampy pain, which is the case for a lot of women, but it is absolutely undeniable that some women have severe pain and they need to be listened to.\u201d<\/p>\n <\/span>Some hospitals now offer deep sedation administered by an anaesthetist.<\/span> Photograph: Posed by models; andresr\/Getty Images<\/p>\n Two incidents forced Busby to reevaluate. The first was learning through a patient about HA and its campaign. The second was her own experience of a colonoscopy. \u201cIt was with sedation, but for me, it was the most hideous, painful thing ever. Some people have no problems with them. I had tears running down my face.\u201d Busby has had a hysteroscopy, too, with no pain relief, and for her, that was fine. \u201cI just think people are wired differently and there\u2019s no way you can predict if you\u2019re going to fall into the one-in-three women who have severe pain,\u201d she says. Busby now offers deep sedation \u2013 administered by an anaesthetist and the patient will sleep through most of the procedure \u2013 to her hysteroscopy patients at her private Spire clinic and her NHS practice at St Mary\u2019s Hospital in Manchester. \u201cNot everyone needs it, but the women who say they need it really need it.\u201d<\/p>\n Consultant obstetrician and gynaecologist Richard Flint offers conscious sedation \u2013 a combination of analgesia and sedative via a needle in your arm \u2013 at his clinic in Chelsea and Westminster hospital. \u201cI\u2019ve been performing hysteroscopies for eight years now, and though many patients are fine with outpatient hysteroscopies, there is a large proportion for whom it is agonising,\u201d he says. \u201cFrom my point of view, I stop immediately and those procedures are really heart-sink moments. You feel you\u2019ve failed the patient.\u201d<\/p>\n In 2023, Flint introduced conscious sedation at C&W, one day a week. They are now expanding it to a five-day service (the only hospital currently offering it for hysteroscopies). They also offer it for other outpatient procedures such as cystoscopies (examinations of the bladder), IUD insertions and manual vacuum aspirations after miscarriage. At the same time, the clinic is trialling the Wid-easy test, a vaginal swab that checks for womb cancer in women with abnormal bleeding. It is already in routine use in Austria and Switzerland, has been introduced in Germany, and is on trial for NHS use in various clinics across the UK.<\/strong> \u201cThat is massively reducing the number of hysteroscopies we need to do,\u201d Flint says. He now has data on more than 300 hysteroscopies performed under conscious sedation, which he is releasing shortly. \u201cThe pain scores are so much better. The average is two out of 10,\u201d he says. \u201cWhat has sealed it for me is seeing patients whose previous hysteroscopies had to be abandoned. They usually say: \u2018Why didn\u2019t I have this before?\u2019\u201d<\/p>\n There are other small signs of progress. The British Society for Gynaecological Endoscopy has recently appointed a female president \u2013 the first in decades \u2013 consultant gynaecologist Rebecca Mallick. This month, Mallick and Royal College of Obstetricians and Gynaecologists (RCOG) president Dr Alison Wright met with members of HA. \u201cAlison and I were shocked and have a lot of things to think about,\u201d says Mallick. At present, RCOG guidelines state that outpatient hysteroscopy patients should be fully informed about the procedure first, and \u201cmade aware\u201d that there are other settings and pain relief offerings, including a general anaesthetic or intravenous sedation. \u201cWe could do a deep dive into why best practice isn\u2019t always happening,\u201d says Mallick. \u201cWe\u2019ve got half a million people on the gynae waiting list, so clinics want to see as many people as possible. Are we giving enough time to talk through all the options or just trying to firefight numbers? We need to look at how we can support hysteroscopists to offer all types of analgesic. We also need to advocate for more funding and resources so we can tackle the backlog and improve care.\u201d<\/p>\n Tylko sees this as part of a much bigger picture. \u201cWe\u2019re a gathering snowball made up of all sorts of gynae-women\u2019s groups,\u201d she says. \u201cEndometriosis UK, Sling the Mesh, women fighting for better maternity care, better IUD fittings. We are getting together and saying: \u2018This has to end.\u2019\u201d<\/p>\n For Harris, any hard-won changes will come too late. She has chosen to have a hysterectomy. \u201cI\u2019ve found a gynaecologist I trust and she is the only one I will let do it,\u201d she says, \u201cbut I\u2019m on the waiting list to see a psychologist first to help me get through it. At the moment, since that last hysteroscopy, every medical appointment makes me cry and panic.\u201d Harris is taking this route partly so that she will never need another one. \u201cI will not undergo any more tests, no more procedures, no more examinations. I\u2019ve reached my red light. This is how I\u2019ll bring it to a close.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":" In February this year, Beth Harris sat in the day surgery waiting room of her local hospital and tried to steady her nerves. She was there for a hysteroscopy, in this case to remove a fibroid. A thin surgical instrument with a lens, a light, a blade and an irrigation system for pumping saline solution<\/p>\n","protected":false},"author":1,"featured_media":51804,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[51],"tags":[21755,25102,2652,25187,3883,1199,1815,18660,418],"class_list":{"0":"post-51803","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-health","8":"tag-agony","9":"tag-barbaric","10":"tag-crying","11":"tag-examinations","12":"tag-eyes","13":"tag-left","14":"tag-routine","15":"tag-womb","16":"tag-women"},"_links":{"self":[{"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=\/wp\/v2\/posts\/51803","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=51803"}],"version-history":[{"count":0,"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=\/wp\/v2\/posts\/51803\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=\/wp\/v2\/media\/51804"}],"wp:attachment":[{"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=51803"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=51803"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=51803"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}