Why is conscious sedation not routinely offered for a hysteroscopy?

[MaMelon]

I've been referred for one of these beauties and have been doing my research, as you do. There's absolutely no way I'm "tolerating" such a procedure (to quote the Dr I spoke to) so have dug my heels in and they've taken me off the outpatients list and have put me onto the GA list - I have to see another Dr first to discuss this, but it will happen. I am not going through it without anaesthetic - for several reasons.

I asked the gynae secretary why conscious sedation isn't offered as standard as it is in other clinics such as colonoscopy or endoscopy, but she didn't know.

Anyone know why? It seems bonkers that it's either outpatient (possibly with local - although from what I've read this isn't effective)or a GA, with nothing in between.

Because no man has had to go through it so never felt the pain and therefore the medical community believe it isn't painful .... I jest .... ish

To be fair, all the Drs I've seen so far have been female.

I’ve bad 2, one with nothing, the other with a bit of local in my cervix, and was absolutely fine. No more uncomfortable than a smear test

I guess for everyone who insists on sedation, there are plenty who are fine without, and it’s a much quicker procedure with fewer staff if they don’t need to knock you out, so costs the NHS less and gets through the waiting list quicker?

I've always been told I'm having them under general both times I had them, maybe as they were doing biopsies but no idea how they decide who gets what.

Actually the second time they were cutting a fibroid out at same time so that might be why that time. And first time they knew I had fibroids, got impression it was so they could do more if needed.

Mine was fine, I wouldn’t even call it uncomfortable. I have had 3 vaginal deliveries though so I imagine for those who haven’t had a vaginal delivery it would be painful.

I've had 2 under GA. It wasn't even offered without but there's no way I'd have had it without GA.

Another one here who's had two hysteroscopy. One was to take a biopsy and the second was to remove a fibroid.
Both were done with me just having taken paracetamol and ibruprofen.
The female consultant was positively giddy with glee when she saw I had had 5 vaginal births though.

And the plus side of having it done awake was that I could ask them for pics of my insides!
I had no idea that this is what my Fallopian tube actually looks like!

It's great that some of you have had it without a GA or sedation, but the figures for those who have a really rough time of it are quite high - anything up to 25%.

I was just curious as to why I've had to push for a GA and why it's that or nothing - it seems really extreme.

I asked for local but they said no you are having a general but no idea why. I've given birth twice and fairly high pain threshold.

I’ve given birth three times but not prepared to even entertain it without anaesthetic for a number of reasons. I’d prefer sedation though - and I would have thought it would be easier and quicker for them too

Mine was done without sedation and I nearly passed out from the pain.

For anyone who’s had any kind of trauma to have to get one of these without GA would be very unpleasant I had one under GA as I can’t tolerate an internal without severe panic due to past experiences . The poster who said about saving the NHS money sorry but that’s the last thing on my mind if I was getting one of these I can think of many other ways to save the NHS money which don’t involve putting women through procedures which they find painful /intimidating /triggering .

A doctor once told me people can go a bit “primal” under sedation, and start kicking off, arguing, fighting, etc. Maybe that’s why?

We weren’t talking about this procedure, but the camera-down-the-throat one.

A doctor once told me people can go a bit “primal” under sedation, and start kicking off, arguing, fighting, etc. Maybe that’s why?

And yet sedation is offered as standard for many other procedures where scopes are used?

A couple of thoughts from an anaesthetist’s POV which may answer some of your question… Sedation is not necessarily a safer option than GA and doesn’t necessarily fix the problem where pain is the issue. Sedation can also exacerbate some of the vagal side effects of cervical stimulation and create some hairy cardiac situations.

Sedation for gynae procedures can also be difficult because with a slightly sedated patient and the altered perception that the drugs can can cause, HCPs (particularly the men) are rather vulnerable to accusations of all sorts. That may sound like defensive medicine, but that is the culture we work in.

The comparison with GI endoscopies isn’t a perfect one - a reasonable number of people do have them without sedation. Sedation doesn’t guarantee success though and we do do GA endoscopies for various reasons.

Hope that helps answer some of your questions

I insisted on a GA for mine. I said I had no desire to be conscious when they popped a camera inside me.

I’ve had one and it was truly horrific - I’ve had 2 x c sections and no vaginal births for context. They were having a problem with something and couldn’t get the tissue sample and so did it 4 times - I was in tears for the last 2 times they did it. It was absolutely nothing like having a coil fitted / removed / smear test. The doctor was very nice and apologised but it was a truly barbaric experience.

Thanks for your response Greybeardy

I would request a female clinician to do the procedure if I was sedated or had no sedation - although other procedures are routinely carried out by men on sedated women with other clinical staff in attendance without it being an issue.

Although a reasonable number of GI endoscopies are carried out without sedation my understanding is that most are.

You mentioned that sedation can also exacerbate some of the vagal side effects of cervical stimulation and create some hairy cardiac situations - can you explain how that might happen please?

I had a hysteroscopy yesterday. No pain relief offered except take your own paracetamol. After 5 minutes of poking around, they stopped and said I have to go back again in a few weeks and have one under GA, because the doctor needs to use a larger instrument.
There is nothing at all offered as an alternative it's either GA or nothing. No sedation or gas and air. I think it's a bit daft. And quite a big waste of time.
I have had a large hernia repair, a colonoscopy and an endoscopy all done under sedation so it doesn't make sense why not this. Although those were all private and I am currently having NHS treatment so maybe that's why.

To me I don't think an endoscopy or a colonoscopy are in any way comparable to a hysterectomy. Both of those are much more unpleasant and painful. An endoscopy makes you gag and wretch and a colonoscopy involves putting a much bigger scope a very long way around the bowel. You can elect to have either of those with just sedation but most don't and Drs advise you not to because it hampers them getting results if you cannot tolerate it.

Surely a fairer comparison is a cystoscopy which is offered without GA or sedation to men and women. I think it's the nature of the procedure and no sexism.

Any time you are sedated or anaesthetised risks increase (although of course it's still very safe overall). My friend has regular colonoscopies for cancer surveillance (poor woman) and she chooses no sedation because the risk of bowel perforation is higher with sedation. For most people the unpleasantness of that outweighs the slightly increased risk but there is increased risk and she chooses not to take it.

• hysteroscopy in above post obviously

Not all 'scopes' are the same. It depends how big the scope is and how far it is travelling. For a flexible sigmoidoscopy ie short scope up the bowel there is no sedation or anaesthetic offered because it's a small scope going a short way.

I honestly think it's just not a fair comparison to say that all scope procedures are the same.

As soon as you start sedating people then risks from that increases of respiratory depression mainly because people's responses can be unpredictable and it requires more safety mechanisms to have a procedure under sedation then without. My anaesthetist friend feels that there should routinely be an anaesthetist present when people are sedated as apparently there is in Australia (in the UK it's only routine for GAs) She thinks we are a bit gung ho about use of sedation in the UK and that it should be taken more seriously.

Thanks 😊

That’s not true about most people not having them for endoscopies or colonoscopies (check the stats) or that Drs advise you not to, and I can absolutely assure you that sedation is offered for flexible sigmoidoscopy. It might not be offered in your Board or Trust, but it is in mine and I imagine others. Cystoscopy - depends whether it’s flexible or rigid. Flexible - local anaesthetic, rigid is GA or spinal. It’s not comparable in terms of levels of pain that can be experienced.

In the Board that I work they offer spinal as an alternative to GA for hysteroscopy - in the Board I’ll be having it they don’t, it’s awake or GA (if you push for a GA or they decide you need it). They are adjoining Boards. The lack of consistency is baffling.