A BBC report has highlighted that failure to offer patients local or general anaesthesia while undergoing hysteroscopy, is resulting in experiences of extreme pain and trauma.
The BBC article, which can be accessed at: https://www.bbc.co.uk/news/articles/c7498yvvjvgo, details women's experiences in which they describe feeling as if their "insides were being ripped out".
Hysteroscopy is a procedure that involves examining the inside of the uterus to help diagnose and treat gynaecological conditions. According to the Royal College of Obstetricians and Gynaecologists (RCOG), a third of those undergoing a hysteroscopy report pain levels of seven or above out of 10.
In March 2020, a survey carried out by the Campaign Against Painful Hysteroscopies group, involving 860 women who had undergone the procedure, revealed the scale of the issue: 520 women, who attended appointments to undergo hysteroscopies, said their doctors carried on with their procedures even when they were in severe pain.
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.
This is despite the RCOG advising clinicians should offer to reschedule with the use of general anaesthetic, epidural or sedation if the pain becomes unbearable.
Around 70% of those surveyed said their hysteroscopist did not immediately offer to reschedule the procedure under general anaesthetic, intravenous sedation or epidural when they experienced pain and distress. Three-quarters said they were not aware of these pain management options before the procedure was carried out.
750 women 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.
New Guideline
Earlier this month, the RCOG announced the publication of an updated version of the Green-top Guideline on Outpatient Hysteroscopy, which recommends that women are provided with information about the procedure of outpatient hysteroscopy, including the benefits and risks, possible pain relief options as well as alternative care settings, prior to their clinic appointment.
It also states that women should be able to choose to reschedule an appointment, once they have received all of the information to allow more time for decision making.
Additionally, since the last guideline was published, the scope has been widened to include information around effective pain relief options, informed consent, training, standards of care provision and clinical documentation.
This guidance will supplement the already published Good Practice Paper, and will be followed by an updated patient information resource on this topic, providing a whole suite of guidance to ensure high quality service provision, as well as person-centred clinical care.
Dr. Geeta Kumar, Consultant Gynaecologist and Vice President of the Royal College of Obstetricians and Gynaecologists, said: “The College is committed to ensuring good quality care for everyone who is offered a hysteroscopy and is committed to promote high-quality clinical practice.
“As a College, we hear the concerns that are being raised by women and people who have had poor experiences of undergoing gynaecological procedures like hysteroscopy, particularly in outpatient settings. While some women experience minimal pain or discomfort, for others it can be an extremely painful procedure and the role of informed decision-making and consent is paramount.
“Clear accurate written and verbal information must be provided, both at the time of referral, and at the procedure appointment. This will support a woman to make an informed choice, including whether they want to proceed with the procedure and if so, their preferences for treatment setting and pain relief options.”
Jane Plumb, Women’s Voices Lead, said: “Women must be well-informed and supported in their healthcare decisions. Many may prefer outpatient hysteroscopy as it may mean quicker recovery and earlier appointments, but some may choose inpatient treatment.
"The decision should always be theirs, based on full information, including on potential pain levels and pain management options in each setting. They should also know they can stop the procedure if it becomes too much. All organisations that offer hysteroscopy should urgently implement this new guidance.”
You can access the guideline here.
