"Extremely painful hysteroscopy"

I was referred to the outpatient hysteroscopy clinic at West Cornwall Hospital after experiencing unusually heavy menstrual bleeding and pain. A previous ultrasound showed that I had an intramural fibroid, so I was offered a hysteroscopy and biopsy to investigate the position of the fibroid and understand its implications for my future health and chances of conceiving.

The patient information leaflet I received in advance of the procedure left me woefully unprepared for the excruciating pain I would experience. It stated that I could expect mild period-like discomfort which most people tolerate well and advised that paracetamol and ibuprofen could be taken prior to the appointment, giving me the false impression that the procedure would feel no worse than others I had already undergone, such as an IUD fitting or cervical smear.

During the brief consultation I received before undergoing the procedure, I expressed how nervous I was to experience pain, and was told I could have a local anaesthetic. I was not made aware that I could choose to have a general anaesthetic, or reminded that I could ask for the procedure to be stopped at any time. At no point was my gynaecological pain history discussed (I have suffered with Vulvodynia since I was a teenager) or my past experience of sexual assault taken into account (both records I presume can be found along with my patient notes).

When the hysteroscope was passed through my cervix I was hit by an astonishingly powerful searing pain and series of sharp contractions - it felt as if my uterus was full of razor blades. The pain was so strong I thought I was going to pass out, and waves of nausea washed over me – it felt as though my body had gone into shock. I shouted out in pain and was told to keep inhaling the gas and air provided. I realised that the local anaesthetic (LA) was not applied before the procedure began and I started to panic, hyperventilate - and sweat profusely, so I was handed a paper towel to wipe my brow. I told the doctor I didn’t think I could bear the pain any longer, but they didn’t offer to halt the procedure and carried on. I felt trapped - like this was something I had to grin and bear despite the evident distress I was in.

One of the nurses present bombarded me with questions (presumably designed to distract me) and I was asked repeatedly about the accuracy of my patient information which I felt was entirely inappropriate under the circumstances. I was not given any choice about whether or not I wanted to see the overhead monitor screen which showed the bloody and clouded image of my magnified uterus. Throughout the procedure the doctor did not verbally walk me through step-by-step and explain what they were doing as I had expected, and so I was left with a continual feeling of suspense/not knowing what was happening next. This combination of factors (being in intense pain, seeing blood, being repeatedly questioned, not knowing what was happening) ultimately contributed to the overall stress of the procedure.

When I requested the promised pain relief, I was horrified to be told that the LA could not be given until the next stage of the procedure, and that in any case it would cause an additional scratching pain on delivery. I felt as though I was somehow asking too much, and being frowned upon. I wondered why these details hasn’t been mentioned beforehand, and told them to go ahead and give the local anaesthetic asap; unfortunately it didn’t seem to make any difference.

After the procedure was completed and a biopsy taken, I felt so dizzy/weak that I thought I might collapse.  I gingerly made my way to the recovery area feeling bewildered and faint. I was offered a cup of tea, but I felt I wanted to curl up into a ball and cry. I was still in a heightened state of anxiety and pain due to the ongoing contractions of my uterus. Incredibly, I was told by the doctor that I’d tolerated the procedure well and given a survey to fill out. A nurse came to take my blood pressure and asked how I was feeling – when I replied that I was still feeling shaky and anxious, the nurse asked why? bluntly, almost incredulously, instead of offering comfort or support. This made me feel as if I were in some way strange or wrong for reacting to the procedure in the way I did.

When I returned home I searched the web to see if anyone else had gone through a similar experience and discovered via the Hysteroscopy Action website that, sadly, my experience is not a one-off; many women all over the country experience intolerable pain during NHS outpatient hysteroscopy, are not fully informed of the likelihood of moderate to severe pain before the procedure date, and are unaware of their options concerning pain relief, which includes being offered a general anaesthetic.

From the moment of my arrival at the West Cornwall Hospital in Penzance I felt I received ‘conveyor-belt style’ care, with staff superficially pleasant but ultimately indifferent to my suffering. I left feeling traumatised, and the experience triggered a period of low mood, tearfulness and anxiety which persisted for many weeks. I experienced nightmares, and had to take time off work.

I understand that hospitals want to save patients’ time and cut down on spending by conducting procedures on an outpatient basis rather than admitting them as day cases, and that a proportion of women will tolerate outpatient hysteroscopy just fine. However, I implore the RCHT to update their information leaflets to reflect the guidance from the Royal College of Obstetricians & Gynaecologists so that all women due for the procedure can make the informed choice that is right for them regarding pain relief, and avoid suffering.