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.

@Fluffycloudland77

You won’t like this but mental attitude makes a huge difference.

I was told it was ok, you’ve been told it’s awful.

I haven’t had kids but I’ve had a lot of gynae investigations with no pain.

You know you’re talking crap don’t you!

I have no problems with smears / coils etc and having had 2 problem pregnancies have had a fair bit of internal prodding. This however was a totally horrendous experience- why are you seeking to dismiss other women’s experiences?

Everyone should also be aware that bowel perforation is regarded as a routine complication of hysteroscopy . This is a medical emergency and will likely result in an emergency Hartmans procedure which is the creation of a stoma and fitting of colostomy bag. This might be temporary and you can then have a reversal operation after 4 to 6 months. Both are major operations involving a week's stay in hospital then six weeks recovery time. If the reversal is not possible or later breaks down the colostomy could be permanent.

@OnGoldenPond

Everyone should also be aware that bowel perforation is regarded as a routine complication of hysteroscopy . This is a medical emergency and will likely result in an emergency Hartmans procedure which is the creation of a stoma and fitting of colostomy bag. This might be temporary and you can then have a reversal operation after 4 to 6 months. Both are major operations involving a week's stay in hospital then six weeks recovery time. If the reversal is not possible or later breaks down the colostomy could be permanent.

It is a complication of most abdominal procedures. It isn't common.

That’s certainly not listed amongst the risk factors, common or uncommon, but I imagine it’s possible as it’s an abdominal procedure.

@MaMelon

That’s certainly not listed amongst the risk factors, common or uncommon, but I imagine it’s possible as it’s an abdominal procedure.

I've not seen it listed either. I would think that the risk of it from a hysteroscopy must be minuscule.

Ignore the scaremongering. If you need a GA then ask for one. I had one hysteroscopy under GA and one without.

The one without was uncomfortable certainly, though not unbearable. I had biopsies done during both of them and that was where the discomfort kicked in. If I was having anything like polyps or fibroids removed then I would certainly be demanding a GA.

We are all different. We tolerate things differently I guess.

Misogyny OP. It's always misogyny.

Female doctors can be misogynists too, any woman can - basically a self hating woman.

@KittyMcKitty

No, it makes a huge difference to outcomes. It’s things like this that put women off smears and then they get cervical ca and die.

You need to be guided by the hcp, I know procedures that will hurt and those that won’t. I act accordingly because I’m not going to put them through something I wouldn’t go through.

I’d be more frightened of LA in a cervix than a teeny hysterscope going through my cervix opening. Putting a needle in your cervix near the nerve? Not fun.

GA is dangerous to health but patients prefer them because them, they don’t see the risks.

@Fluffycloudland77 so you’re saying my experience was down to a lack of positive mental attitude? Seriously? I would never seek to dismiss your experience so why are you seeking to dismiss mine?

[quote Fluffycloudland77]@KittyMcKitty

No, it makes a huge difference to outcomes. It’s things like this that put women off smears and then they get cervical ca and die.

You need to be guided by the hcp, I know procedures that will hurt and those that won’t. I act accordingly because I’m not going to put them through something I wouldn’t go through.

I’d be more frightened of LA in a cervix than a teeny hysterscope going through my cervix opening. Putting a needle in your cervix near the nerve? Not fun.

GA is dangerous to health but patients prefer them because them, they don’t see the risks.[/quote]
You display an astonishing lack of empathy for a healthcare professional. You think because you’d be OK with this then other women should?

I hope I never encounter you, professionally or as a patient.

You need to try things, if it’s not working you say stop because they can’t proceed after consent is withdrawn.

But you need to approach things positively. If something is offered with no GA you its because the balance of risk v benefit isn’t really working.

It does make a difference though & you can tell a nervous patient when they sit down, they do much worse than the relaxed ones. Usually it’s family members, particularly husbands who wind patients up to fever pitch. I’ve seen patients sobbing it hurts while a clinician isn’t touching them after LA & we have to stop.

One of my colleagues went off with cervical ca and was not expected to return because of embarrassment around smears and the “0oh it might hurt” attitude. Her dd made her go to the dr in the end.

You can always say stop and withdraw consent during a procedure.

You’ll do better with healthcare if you have an open mind because people are genuinely trying to help keep you healthy & gynae are so gentle.

Unless you’ve seen thousands of patients it’s hard to imagine that you can look at a patient & know their not going to have a good experience when you take them in.

The minds very powerful & you can’t dismiss it.

The minds very powerful & you can’t dismiss it.

No shit Sherlock.

I've had 2 hysteroscopies, for me it was excruciating. Both to remove fibroid and cysts. Honestly, pain was like childbirth.
2nd one I had a local anaesthetic and the pain was slightly better.
The whole experience was traumatic and quite degrading, even though the female Dr's and nurses were lovely.
Definitely have a general anaesthetic if you can op. It should be a first option for everyone.

Oh my goodness Lookingforthecoffeerevels ,that sounds awful ☹️

The British Society for Gynae Endoscopy put out a statement in 2018 to say that it’s important that women are offered the choice of having one as an outpatient or under GA from the outset - so I will go with that expert view.

They also say that some centres can offer conscious sedation in a safe setting, so they absolutely recognise the importance of choice (over the power of thought )

@MaMelon

That’s certainly not listed amongst the risk factors, common or uncommon, but I imagine it’s possible as it’s an abdominal procedure.

It was listed as a known complication on the consent form for my hysteroscopy. It is a less common one but still common enough to be a consideration.

Everyone is different.

I have had this done and positively refused a GA. I don't like having those unless absolutely vital as they are risky no matter what . It's such a faff not having to eat, not being able to drive, having to have an adult with you for 24 hours after.

I didn't find it painful. It was agreed that if it was, I could have a local in the cervix. If the dr is good, they can gradually dilate the cervix. It's not a case of ramming the scope in.

I've had a coil inserted once and to be honest that was far more painful.

@Topseyt

The risk is not minuscule, it is a standard complication listed on the consent form. Uterine perforation is fairly common and it is not unusual for the sigmoid colon to lie over the uterus during the procedure. If a uterine perforation occurs it is not that difficult for the instrument to then perforate the colon.

Yes - uterine perforation is listed, bowel isn’t listed as a risk on anything I’ve seen. I suppose some patient info will cover all possible eventuality.

As a HCP with extensive gynae experience, I would disagree about judging a patient by the way they act. Some are having hysteroscopy for potential cancer, I would be more surprised if they were not nervous. I would not undergo any of these procedures without sedation, not necessarily GA as that has its own problems.

I do know womens health care is not taken as seriously, maybe still due to old fashioned views, it is time it stopped,.hysteroscopy is painful for the vast majority of patients I have seen.

I was offered a GA for mine straight away and as I find it painful having smears I took that option. When I was in the hospital they ended up giving me a spinal as they said it was better if you contracted covid. Anyway it was all fine and I got to see inside my womb too. Mine was also due to post menopausal bleeding.

I had 2 (admittedly combined with ablation), was supposed to be under GA but due to an issue landed up being a spinal block. Nothing other than a GA was discussed, I do wonder if that was due to my consultant being female!

[quote OnGoldenPond]@Topseyt

The risk is not minuscule, it is a standard complication listed on the consent form. Uterine perforation is fairly common and it is not unusual for the sigmoid colon to lie over the uterus during the procedure. If a uterine perforation occurs it is not that difficult for the instrument to then perforate the colon.[/quote]
You keep banging on about this. I've never seem perforation of the bowel listed.

Have you seen a scope used for this @OnGoldenPond?
It's tiny- roughly 2-3mm across and it's a lens at the end not a scalpel.

It would be a very cack handed surgeon who perforated both the uterine wall and then the bowel, especially as they are looking at a screen when doing the procedure.

I had one without sedation (just local anaesthetic) and it was fine. But i recognise we are all different. Dp had a colonoscopy without sedation recently too