Doctors use pandemic as excuse not to offer effective pain relief claim campaigners

At least 70 women who have had hysteroscopies this year in English NHS hospitals said they were left in extreme pain following the procedures, with many suffering trauma for several days, according to a survey by the Campaign Against Painful Hysteroscopies group.

Some women claimed doctors used covid-19 as an “excuse” not to offer sedation or general anaesthetic. Others said they were offered an inpatient appointment with general anaesthetic, but were also told it would be a long wait and would likely be cancelled due to covid pressures.

Women also said they were told an outpatient procedure would reduce the time spent in hospital and consequently reduce the risk of contracting covid. The only pain relief on offer was often just ibuprofen and some women said facilities like recovery rooms were unavailable.

The vast majority of the women surveyed — more than 90 per cent — said they were traumatised for a day or longer by the pain from the procedure, which uses narrow telescopes to examine the womb to diagnose the cause of heavy or abnormal bleeding.

Around 70 per cent of those surveyed said their hysteroscopist did not immediately offer to reschedule the procedure under general anaesthetic, intravenous sedation or epidural when they experienced pain and distress. Three-quarters said they were not aware of these pain management options before the procedure was carried out.

‘Vital that women are listened to’

The Royal College of Obstetricians and Gynaecologists has advised clinicians to offer more intervention if the pain during a hysteroscopy becomes unbearable.

A RCOG spokeswoman said: “We are concerned to hear that women are going through painful and distressing hysteroscopy procedures and that they feel covid-19 is being used as an excuse not to offer a choice of anaesthetic.

“The covid-19 pandemic has put incredible strain on the health services, and the risk of transmission of the virus has meant they’ve had to adapt their procedures. Whilst all women should be offered a choice of anaesthesia and treatment settings for hysteroscopic procedures, an outpatient setting avoids hospital admission and reduces the risk of exposure to the virus.

“The RCOG guidance on this is very clear — all pain relief options should be discussed with women, as well as the risks and benefits of each. Women should be given the choice of a local or general anaesthetic.

“If the procedure is still too painful, no matter what anaesthetic options are chosen, it must be stopped and a further discussion of pain relief options should then take place. It’s vital that women are listened to and their choice is fully supported.”

However, the spokeswoman added that, although hysteroscopies can be “very painful” for some women, in most cases the procedures are “quick and safe” and involve “minimal pain or discomfort”.

‘End the gender pain-gap’

The campaign told HSJ it was “appalled” that many trusts “continue to inflict harrowing procedural pain” on women through “wilful blindness” of official guidance.

A campaign spokeswoman said: “Despite years of Parliamentary campaigning, most trusts still negligently deny women full information about the right to choose general, regional [or] spinal anaesthesia, thus making patients’ ability to give full informed consent impossible.

“These affected patients may be left traumatised and scared of returning for further gynaecological procedures, including cancer tests and treatment.

“Covid or no covid, it’s time for the women’s health minister to end the gender pain-gap and for the NHS to stop pretending that all women prefer endoscopy of the womb with just ibuprofen and hand-holding.”

A study in the British Journal of Anaesthesia estimated 25 per cent of hysteroscopy patients report experiencing intense or intolerable pain, and that local anaesthetic “does not guarantee effective pain management”.

An NHS England spokesman said: “[RCOG] provides detailed clinical guidance on these services which clinicians should be following.”