End barbaric NHS hysteroscopies with inadequate pain-relief
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The Campaign Against Painful Hysteroscopy www.hysteroscopyaction.org.uk has amassed hundreds of stories of severely painful NHS outpatient hysteroscopies performed with no or inadequate pain-relief on women of all ages, shapes and sizes. Many patients have gone on to suffer PTSD. None have been warned of the <25% risk of severe pain reported in recent NHS audits.
The words our campaign hears over and over are ‘barbaric’, ‘medieval’, ‘torture’ and ‘violated’. Many women weep, faint or vomit. They are wrongly led to believe that they are unusual or making a fuss. Most are too embarrassed to complain. Their experience is often recorded in the letter to the GP as ‘tolerated the procedure well’.
Hysteroscopy is the examination of the womb by a miniature camera at the end of a very thin, rigid metal tube. The hysteroscope is passed through the vagina and cervix into the womb, which is kept pumped open with water. Miniature surgical instruments are passed through the tube to take a biopsy and, if necessary, to remove polyps or small fibroids.
NHS hysteroscopy/biopsy of the womb is usually performed in outpatients with the patient awake. It is sold to women as usually causing only ‘mild discomfort’.
Unlike NHS colonoscopy and gastroscopy, patients undergoing hysteroscopy are not offered safely monitored conscious sedation. Local anaesthetic is seldom used since an injection into the cervix can cause fainting. Women with a closed or narrowed cervix (i.e. postmenopausal or not having gone through vaginal childbirth) are not warned that dilating the cervix can be excruciatingly painful.
Patients are instructed to take over-the-counter paracetamol/ibuprofen upfront. Stronger painkillers are not recommended and seldom given. There is no separate appointment for pre-operative assessment. A nurse provides vocal distraction (in the form of hairdresser chit-chat) and maybe a ‘stress ball’. Some patients, having taken just a paracetamol, are subjected to electro-surgical removal of polyps or small fibroids.
To protect our grandmothers, mothers and daughters from unnecessary pain and trauma,
We ask the Secretary of State for Health to change the barbaric manner in which many NHS hysteroscopies are currently performed. Specifically, to ensure that:
1. All NHS hysteroscopists have advanced training in pain medicine.
2. All hysteroscopy patients receive full written information before the procedure, listing the risks and benefits and explaining that local anaesthetic may be painful and ineffective against the severe pain of cervical dilation, womb distension and biopsy.
3. All hysteroscopy services are adequately funded so that BEFORE their procedures patients may choose no anaesthesia/ local anaesthesia/ safely monitored conscious sedation/ epidural/ general anaesthetic.
4. The Best Practice Tariff financial incentive, which rewards NHS Trusts who perform a high percentage of hysteroscopies in outpatients without a trained anaesthetist, is abolished.
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