Dd (19) was refused transvaginal ultrasound

[seventyfivepercent]

Dd, now 19, has had incredibly painful periods since they started at age 13. For a few days each month she is doubled over with pain, vomiting and unable to go about day to day life.

The rest of the time she is constantly exhausted with regular headaches. Blood tests have shown she is anaemic and has inflammation. The GP doesn't seem to think the tiredness, headaches and blood results are connected to the period pain.

After years of going back and forth and being swapped from one contraceptive pill to another to try and ease the pain they finally agreed to send her for a transvaginal ultrasound, Dd was so relieved they were finally taking her seriously.

When Dd got to her appointment they refused to do the transvaginal ultrasound due to her being a virgin, and would only do an external ultrasound, this showed an enlarged ovary but wasn't clear enough to see properly. The sonographer actually said they don't like to do internal ultrasounds on virgins as they don't want that to be their first experience! I was gobsmacked and having looked into it this goes against guidelines. Yes, they should explain it might be a bit painful or uncomfortable, but the decision to proceed or not should have been Dds.

Now at her follow up GP appointment they've gone back to saying it's all normal and she just needs to keep taking he contraceptive pill, she's so fed up with being fobbed off.

I'm suspecting endometriosis, but the GP said she doesn't have the symptoms. Has anyone had success demanding an endometriosis laparoscopy, or do we have to resort to going private? I should add, I haven't been to any of these latest appointments as Dd is now away at Uni seeing her local GP, she's just asking me for help as to what to do next.

Thanks for any advice!

I really feel for you as I had to fight for 14 years for my endometriosis diagnosis, and I remember going to appointments at her age and being fobbed off. If it’s any slight consolation, an ultrasound can’t always conclusively diagnose endo - it can sometimes pick it up, but not always. You’re right in thinking that a laparoscopy is the best option - this remains the gold standard for diagnosis.

I think going back with her is a great idea, she will feel bolstered by your support. Debilitating, disabling period pain is NOT normal. Insist on a gynaecology referral. I don’t see that they can refuse, your daughter is suffering and they’ve not established why. Gynae is the next logical step. If you’re near a city, see if you can find out where your tertiary centre for endometriosis is and ask to be referred there under Right to Choose (in Manchester it’s St Mary’s - not sure about elsewhere). Good luck x

That's an informed decision for an adult woman to make not a male doctor to sexualised.

I've had symptoms since 13 and got my first internal US at 20 and also sent away with the pill for suspected endometriosis. They can't diagnose without a lap anyway as it could be all over and requires excision (not ablation) (about £6000). It's terrible trying to get help for this, I've been trying to get a lap on the NHS for a decade. The current wait list is 5 years, I've spent 3 years undergoing private IVF and still no sign of a lap. A hysteroscopy can show adenomyosis (£3500 here) and can be done under sedation, but that's not adequate for a full diagnosis and treatment. I'm sorry she's going through this too.

In that case I really think I would complain. What a weird comment to make.

Why is he inventing his own procedures? If it's not the official NHS procedure to ask if the patient is a virgin then surely he is breaking all kinds of rules? Did he actually ask her "are you a virgin?" ?! If so I think that's awful and he should be reported. I mean maybe he was trying to what he thought was the right thing, but surely he needs to follow guidelines and protocol? He has wasted NHS and a patients time as a result.

Your replies are strange. For the record, it's disgusting to imply a vaginal probe is like a penis (wtf?!) and it's disgusting to take charge of a patient's 'virginity'.

You also wrote: risk of vaginismus (which is certain in this case) You're kidding?! You think a normal young woman, who uses tampons, is going to seize up in shock at having something medically inserted into the vagina?

Are you also of the view that a 25-year-old woman, who hasn't yet had sex, shouldn't get a pap test due to the 'certainty' of vaginismus?

I really hope you're a bog-standard hairy handed creep and not a medical practitioner.

I’m going slightly against the grain here, but I think it was good to have at least questioned the procedure.

I was a virgin when I had my first smear test in my early twenties, and the nurse only asked me if I had already had sex once I’d had some discomfort and bleeding - during the procedure itself. There was probably no point in even doing the test on me.

It would have been good to have asked me the question and to be warned about the possible discomfort

Having had sex doesn't make any difference to the discomfort level of a vaginal medical procedure, @Socialmediashy. You know sex doesn't really stretch the vagina, right?

Some women might experience discomfort if they have an unusually thick hymen, but most of us have stretched/broken them by our late teens.

Well, yes, one of my friends in her thirties refused a TV ultrasound and demanded TA.

Ive had a few TV scans and they are not a walk in the park for everyone. I found them very uncomfortable.

You suspect endometriosis. You only refer to her being in pain during her period. With endo, the pain is their constantly believe me. It's worse during the period. So the gp's correct at the symptoms aren't there.

A TV ultrasound wouldn't necessarily have shown it either, the only definitive confirmation being a laparoscopy. You don't want to get into that at her age. Procedures like that are not without risk.

There may well not be a diagnosis for this you know. I had absolutely hellish periods when I was a child and teenager and early twenties. They gradually improved as I aged.

If you can afford to I’d send her for a private MRI. She’ll have a diagnosis in no time.

DH and I are in Brazil and he had an issue, they diagnosed and said he didn’t need a CT scan. Because it’s private he asked for one anyway… £30 later he’s diagnosed with a different condition than they said. Would’ve taken months on the nhs.

I don't normally agree with the calls to complain about NHS staff on these sort of threads but in this case yes I would advise her to complain about this experience. She was refused a diagnostic exam that she was referred for and entitled to.
It did use to be common practice to not perform internal scans on virgo intacta patients however that has generally changed and it's now accepted that patients over 16 may have internal scans with their consent. So it may be that the sonographer was out of date in their practice however I still find the explanation creepy and inappropriate. Would be interesting to know what their protocol states for this situation and whether it was being followed correctly.

I'd say to her:

Complain about him.

A man choosing to go into a field where he'll spend all day every day with his hands and instruments up women, then equating what he's doing to a sexual experience? Needs investigating.

Creepy, misogynist and weird.

Also since when was the NHS been remotely bothered about hurting women with gynae procedures?

Then go back armed with your research and demand further investigation, refusing to be fobbed off.

I was previously a Womens Health Physiotherapist and I am female. I am assuming you are from the US and possibly male given your terminology and lack of understanding of the issue.

There is a difference between the size of a vaginal probe and the size of a tampon. A tampon is inserted by the individiual in private, a probe is inserted by another person in a hosptial room. You can use tampons and still have vaginismus all women know this.

Women who are virgins do not get smears because they are not at risk of cervical cancer having not been exposed the HPV.

I am reporting this thread as I suspect some malicious contributers on here trying to get women to talk about thier gynae experiences.

@2021x

If you’ve never had any type of sexual intercourse, you’re unlikely to have HPV. However there are other risk factors for developing cervical cancer, such as family history and smoking.

https://cervicalscreeningaware.co.uk/

Traditional concept of virginity plays no part in clinical decision making.
No woman should ever be denied access to healthcare on the grounds of virginity.

https://www.bmus.org/media/resources/files/Hazel_Edwards_SheffieldGynae_study_day_TVUS_2024_BA0uEvD.pdf (British Medical Ultrasound Society)

DD2 was fobbed off by GPs for years with the pill. She was vomiting regularly. I used to ask her every afternoon, what could she eat for dinner? Their specialist in gynaecology said, it wasn’t endometriosis - perhaps a bit of IBS? Eventually I went with her, aged about 22, to ask for a referral to a gynaecologist, as I’d met numerous women with endometriosis at an IVF clinic. After 10 minutes, the consultant gynaecologist said, she had all the classic symptoms of pelvic endometriosis and agreed to a laparoscopy. He dealt with widespread endometriosis during the laparoscopy. A theatre nurse told us afterwards, she should change GPs.

Her OH, a trainee GP insisted her GP refer her to gastroenterology. They found she had adhesions on her bowel, which twisted her transverse colon. The consultant said food would get held up there, causing loss of appetite, nausea, vomiting, wind, etc! He recommended a low fibre diet, and Movicol when necessary!

Even after that, GPs still said things like she was young to have endometriosis! I’d say, GPs don’t know the first thing about it. Nobody considered it could affect her bowel - she was always told by GPs, that the loss of appetite, vomiting, etc was caused by stress and anxiety!

Many GPs are not up to speed when it comes to endometriosis. I’ve had one of them tell
me that endometriosis is not common when in fact it’s the second most common gynae issue seen in women after fibroids.

Any pain that is cyclical in nature and or gets worse up to and including menses should be checked to see if endometriosis is present.
Ops daughter has been let down here by both the Gp and the sonographer who did not do his job. Not that you can see endometriosis on such a scan anyway but that is beside the point. He needs reporting to PALS.

Indeed endometriosis can get into the intestines causing all sorts of problems. Many women with IBS likely have endometriosis instead.

You need to make a complaint against this practitioner. That’s a disciplinary offence. He should not be sexualising a medical procedure.

it’s normal. for a reason. the probe also is nothing like a tampon. of course they mention sex because it’s relevant. why would a different GP say different?

Referring to it as her "first experience" in the context of her virginity is pretty disgusting to me. I doubt a female doctor would have spoken in those terms.

I have been told by two people who work in the health sector (although not doctors) to call 111 to get a second opinion. They were two separate occasions when I felt let down by my GP. It was a long time ago now.

I just thought this might be an alternative to changing your GP. I changed mine and it really was a case of out of the frying pan into the fire. It seems to me the only difference changing surgery might make is for patients to appear difficult

I was also diagnosed by a TV scan but that was done by an endometriosis specialist, and my endo was so severe (stage 4 rectovaginal) that he was able to see a rectovaginal endometriosis nodule on the TV scan and could diagnose me from that. I'd also had loads of other ultrasound scans over the years by radiographers and general gynaecologists who all missed the endo, so I think a lot of it is down to the expertise of the person doing the scan as well as endo severity.

Yes this is me. I was told for years that my bowel issues and pain was IBS, but it was actually stage 4 rectovaginal endometriosis.

I’ve had more internal ultrasound scans than I care to mention and none of those detected the endometriosis present. It’s usually diagnosed via laparoscopic surgery.

It took 7 years for my endometriosis to be diagnosed as I was fobbed off over and over again. Had male doctors tell me some women have heavy periods and that’s normal. It was only after my THIRD iron infusion failed to correct my anaemia they took me seriously. But even once diagnosed the treatment is nothing more than here are some painkillers now get on with it.

Has she had a gynae referral?