Hysteroscopy without anaesthetic is a women's rights issue

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'Being a woman means living with pain!'

Ever heard that lie?

Ever nodded along with it, resignedly accepting some intrusive gynaecological procedure that causes you excruciating pain?

BECAUSE THEY WERE OPERATING ON YOU WITHOUT ANY ANAESTHESTIC?

Are women having private treatment offered anaesthesia for hysteroscopy?

DM has had many steroid injections into joints. NHS injects pain relief at the same time. DM found the steroid+PR injection excruciatingly painful. After a few years she went private and was astonished to discover that the standard procedure was to inject the pain relief first. The injection of steroids was barely more than uncomfortable. For the next few years she had only private steroid injections. The next time she had it on the NHS she insisted on pain relief first. And got it, even though she had to fight for it and the doctor tried to persuade her that made no difference when the PR was injected. With PR first, the NHS injections now hurt just as little as the private ones did.

I wonder if men having invasive exams or procedures on their genitals are now also being given letters telling them there will be no anaesthetic due to Covid. I really do wonder.

It's amazing to me that a male OB, James Young Simpson, went against the establishment at the time to make the use and option of use of pain relief during childbirth a thing 170 years ago but we're back to this. Sure it was quite a blunt tool looking back but it was a novel thing to even suggest it was possible, much less desirable in some cases. Imagine! A man who thought that maybe women shouldn't have to suffer pain unnecessarily for being female.

@StellaAndCrow exactly, I’d signed the consent forms for that op having been told I’d be given morphine and kept in four nights . In reality I was stitched up and discharged less than 24 hours later with my mum and grandmother having to hold me up to get me in the car .

I genuinely don’t believe any other speciality would treat a patient in that manner , there’s no way they’d give a man extensive surgery to his genitals and then tell him to get up and get on with it, it wouldn’t happen . I worked on a surgical ward for years - different world to gynae .

Even as late as 2017 my hospital still had a nightingale style gynae ward - twenty beds in one massive room, only two toilets . They’d do internal examinations behind the curtains at visiting time despite having two private examination rooms - no privacy or dignity for anyone .

I'm so sorry, namechange

Many postnatal wards are like that, women being examined intimately behind a curtain with, pre-Covid, literal crowds of visitors in the same room.

It's not patient thing, it's a woman thing.

I had to stay home when DH had his vasectomy as I had 3 young children and he had to travel some distance due to our location. A male friend took him. He was treated with utmost respect and dignity and, of course, had been offered choices of pain relief at a consultation appointment, with each explained to him but no pressure on choice; told to fast in case he found the pain too much and needed more extensive pain relief and if that was so, there'd be a wait for later in the day to get it, monitored after, given instructions post-op.

Yet in this thread alone we have women being held down, vomiting and crying out, women being snapped out for being fussy and not bringing pads with them, etc etc.

Just a few months ago a woman posted her experience of trying to have one of these procedures under local and how she was made to feel for not being able to tolerate it (she had never given birth before). She was made to feel like shit and fussy and was in bits.

It is barbaric. I wouldn't have anything done without sedation but would rather have a general.
And yes to being prescribed paracetamol after c sections! I had my first abroad and got some lovely drugs. Second one was in the UK and paracetamol.. after being cut open while looking after a newborn..

And yes when I've had internal examinations I've been told to stop being ridiculous when I scream in pain or say please be gentle. Fucking sadists.
Totally puts me off having a smear.

a male OB, James Young Simpson, went against the establishment at the time to make the use and option of use of pain relief during childbirth a thing 170 years

And the reason for the establishment's objections: Unto the woman he said, I will greatly multiply thy sorrow and thy conception; in sorrow thou shalt bring forth children; and thy desire shall be to thy husband, and he shall rule over thee. Genesis 3,16

We've come so far in 170y, yet in some ways we're still chained to the same spot.

@CookPassBabtridge

And yes when I've had internal examinations I've been told to stop being ridiculous when I scream in pain or say please be gentle. Fucking sadists. Totally puts me off having a smear.

I'm one of those women for whom they cause no pain or problem, I've even been a volunteer for medical students and student nurses and midwives to practice, multiple times and in multiple situations. But far be it from me to assert that, because that is my experience, or even that of 'most' women, that it is universal and therefore other women and their experience and pain does not count and should not be considered, because that, my friends, is what misogyny is all about.

This is the link to the government women's health consultation. The deadline is the 13th June. Hopefully it would be worth sharing these experiences with the government consultations.dhsc.gov.uk/talkwomenshealth

I had a gynae appointment for what I thought was a chat about the possibility of a hysterectomy, and was expecting a pelvic exam. Maybe a smear.

While I was there he said well you are here now and now I have you I can just do this procedure called a hydrosctopy which will give us a clearer picture as your smear wasn't brilliant and I also want to do a biopsy.
I could give you a bit of local anaesthetic but that would mean you having to come back another day and it's such a fuss to get an appointment so why don't we just get it all over and done with yes???

I hadn't heard of or researched any of these things, I was in a bit of shock that my smear test "wasn't brilliant" and it all happened very quickly

It was the most painful thing I have ever experienced, ever. I vomited when he took the biopsy and then after I was quickly ushered out of the room to get the bus home I had to go into A&E on the ground floor of the hospital to get a seat while I rang my Mum instead to pick me up.
There I was so grey and ill looking one of the A&E staff came out to see if I needed to sign in and I said no I'm going home after being butchered in gynaecology.
I feel now like it was something from The Handmaid's Tale.
I bled solidly for 6 weeks. For three of those with hideous labour like pains. As it turned out the coil that had been inserted at the same time hadn't been put in far enough and my uterus thought it was in labour. So for 3 weeks I went between the GP, A&E and then finally back to gynaecology who only put the speculum back in when I threatened to take the coil out myself.

On the other hand, I've had both a colonoscopy and gastroscopy without any sedation and while unpleasant were fine to get through.
Likewise, I had a pretty easy natural labour and until this smears etc were never something I was concerned about. Just shows how pain, and the Drs attitude to the patient in front of them is so different for everyone

Did you ever share where your statement that 94% of women find a hysteroscopy “acceptable” with just a couple of paracetamol, @LemonRoses?

@Elisandra

Did you ever share where your statement that 94% of women find a hysteroscopy “acceptable” with just a couple of paracetamol, *@LemonRoses*?

No, I don’t think it was requested but;

obgyn.onlinelibrary.wiley.com/doi/10.1111/ajo.12560
Reports 88% saying they would have another.

www.scielo.br/j/eins/a/zV44nK6qNTnQCMDGZgbvSXx/?lang=en

obgyn.onlinelibrary.wiley.com/doi/abs/10.1111/j.1471-0528.1998.tb10185.x

93.3% in this study.

I think that because the vast majority tolerate it, that becomes even more important to ensure that there is proper, fully informed consent and explanations about alternatives to ensure those who do find it too traumatic still have access to appropriate diagnostic procedures.

That first study doesn't mention what pain relief was offered does it, unless I've missed it? For example what percentage of patients had a paracervical block?

From the second study: Nevertheless, in a considerable number of cases, women perceived hysteroscopy as painful. Pain perception was linked to individual pain threshold and surgeon experience, but not to pre-procedural anxiety state levels, ethnicity or abnormal hysteroscopic findings. Is that really an acceptable standard of care?

And the last paper refers to that word 'tolerable'. So depressing to see that this is a benchmark of care.

Not a hysteroscopy, but I can barely tolerate internal exams after the roughest internal examination ever when I was miscarrying. The thing that examined me looking for retained products of conception was so rough I went into cervical shock. There is no way I will ever have one of these procedures without a general. I can barely, barely tolerate smear tests.

This thread has been an absolute revelation to me.

Some months ago I went to have a new IUD inserted. When I was in the chair, in the stirrups, speculum in, the gynae asked to do an endometrial biopsy.

I asked why & was told >40, break thru bleeds on mirena, better safe than sorry.

I literally knew this wasn't informed consent (I teach this topic at graduate level) & I still consented. The gynae is an eminent gynae oncologist so of course I wanted him to check this very important thing.

It was beyond hideous. I was sweating. In so so much pain - I needed a vomit bowl at one point. After 2 biopsies i had to tel him to stop. He examined the biopsies & said he wanted to take one one.

I grudgingly agreed as I didn't want an equivocal result.

Finally after 30/40 mins he inserted the IUD.

I bled for 6 weeks. I was absolutely shaken. I needed to go home (I was mid shift at work). I felt ghastly for days.

Months later I cannot believe I had this procedure with no anaesthetic. How on earth did I, an assertive health care professional who works in reproductive health allow my colleague to do this to me?

AND I GAVE HIM A BOTTLE OF WINE AS A THANK YOU.

Absolutely agree that female pain and distress from invasive gynaecological procedures is a feminist issue. The way that women are treated as less than fully sentient beings with autonomy and a right to information raises massive issues for patients and professionals and contributes to other problems and keeping women away from healthcare after these awful experiences. And the psychological impact it has on us before, during and afterwards seems to be ignored. It’s misogyny.

This thread had been really hard to read. Like others I have passed out and had to go into recovery from apparently trivial cervical procedures.

@AllOptionsAreOnTheTable

That first study doesn't mention what pain relief was offered does it, unless I've missed it? For example what percentage of patients had a paracervical block?

From the second study: Nevertheless, in a considerable number of cases, women perceived hysteroscopy as painful. Pain perception was linked to individual pain threshold and surgeon experience, but not to pre-procedural anxiety state levels, ethnicity or abnormal hysteroscopic findings. Is that really an acceptable standard of care?

And the last paper refers to that word 'tolerable'. So depressing to see that this is a benchmark of care.

What word would be used instead of tolerable? I can’t imagine anyone doing anything other than tolerate it - it’s not something you’d choose as a birthday treat, is it? I tolerated it as I tolerated vaccination needles or mammograms. Something not enjoyable but needing doing.

But what is the standard of pain for "tolerate"? Not passing out? Excruciating pain but resolves quickly? Didn't punch the consultant in the face?

I was probably classed as "tolerating" mine despite having to be physically pinned down in total agony.

@Greenelefant

But what is the standard of pain for "tolerate"? Not passing out? Excruciating pain but resolves quickly? Didn't punch the consultant in the face?

I was probably classed as "tolerating" mine despite having to be physically pinned down in total agony.

Tolerate: to be capable of continued subjection to (a drug, toxin, or environmental condition) without adverse reaction.

@Greenelefant

But what is the standard of pain for "tolerate"? Not passing out? Excruciating pain but resolves quickly? Didn't punch the consultant in the face?

I was probably classed as "tolerating" mine despite having to be physically pinned down in total agony.

Physically pinned down without consent is not tolerating - it is assault. Did you tell them to stop and they refused? That would require a referral to the GMC/NMC.

After my experience where the gynae called the nurse doing the vocal-local hand-holding "stupid" for telling him that I was insisting he stop, I will never have one without GA again.

This man was happily causing me immense pain but ignoring it. He carried on, ignoring my physical and emotional distress. I threw up, was sweating, crying and shaking. Panicking about not being able to breathe while another nurse was trying to clean up and reassure me. The vocal-local nurse shouting at him to stop panicked me even more.

All this when I expected, like others, a discussion about my TVS scan that I'd told him I'd found painful. I'd also told him that I was very uncomfortable with the procedure going ahead as I was still under psychology for sex abuse and would rather have gone home and prepared for it.

I was told I'd be wasting a precious and expensive NHS appointment if I didn't go ahead there and then.

Would he see his mother/sister/wife/daughter go through that to save some time and money?

It's all about cost, isn't it? It's cheaper to have someone walk out straight after a procedure than prep them, administer GA then have them in a bed for the rest of the day.

Monetary cost trumps the emotional cost to women.

I'm physically disabled and have pain conditions (fibro and CRPS). I feel pain 'differently' to others but the emotional pain this procedure cost me has lasted to this day. It only took a few weeks for the bleeding and physical pain to subside.

My BIL was offered GA for a colonoscopy, which he took. Six months previously my sister wasn't but asked for it for hers. She was told it would cost more and had more risks, that she would be far better off not having it. She also has fibro and found it excruciating.

Why do they offer men but guilt-trip women?

Are women having private treatment offered anaesthesia for hysteroscopy?

Yes. My gynae consultant does them under GA if the patient has private insurance. They will also do them under (cheaper) deep/twilight sedation if the patient is self-funding. I’ve had both of mine under GA.

I have people rummaging around my vag on a depressingly frequent basis due to infertility and endometriosis. I’m fortunate that everything has been done privately with very kind consultants and I’ve never tried to seek treatment with the NHS. I only discovered via Mumsnet that hysteroscopies were routinely done without sedation - bloody barbaric.