Painful hysteroscopy

*Trigger warning. This post includes personal gynaecological experiences of a traumatic nature.

What is your experience of having a hysteroscopy? We would like to hear - good or bad so that we can help campaign for safer, harm free care. 

You can read Patient Safety Learning's blog about improving hysteroscopy safety here.

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I had an horrendous outpatient hysteroscopy 

Referred after pm bleeding, having started menopause aged 36. 

Researched online before and saw some women had experienced pain. I specifically asked the dr on more than one occasion if there was a chance of pain. He said have you given birth vaginally?, I replied yes, to which he said the worst i would feel would be akin to period pain. It was barbaric, i was crying and passing out with pain.  The nurses in the room with me simply tried to chat about inane topics to distract me! Was unable to walk back to my car fir about 2 hours after as each time i stood up and began to faint again. 

I am appalled that in 21st century Britain,  the NHS is still allowing this

Here's a link to my full story https://hystericalwomen.co.uk/2019/12/11/the-most-painful-moment-of-my-life-the-national-scandal-of-barbaric-outpatient-hysteroscopy/

Really sorry to hear this.   There must be places that do this procedure well.   It would be fantastic to hear about what ‘gold standard’ is and ensure all women have this same standard of care. 

Mine was 3 years ago at the Cotswold Suite at Southmead Hospital, Bristol.  The first I knew that I was going to have a hysteroscopy was when the booking in clerk rang me to arrange it.  She assured me I would have a LA, as did the consultant's secretary when I rang her to check it out.  I was told I might experience mild cramping, so to take paracetomol or iboprufen an hour before my procedure.  I had already had a painful biopsy and found an internal scan to be very uncomfortable, so I was a bit nervous.  My husband accompanied me, but I was taken away from him and left to sit in a freezing cold corridor for half an hour over my allotted time.  All I could hear were women laughing loudly, so I assume the staff were on a break.  When I went in I explained that I was nervous of the pain and the hysteroscopist said it might be a bit painful, but like period cramps (they kept telling me this all the way through)  This was the first I was told that they don't do a LA and I was told that lots of reasons why a GA was not a good idea - I had never considered a GA before this.  I had previously had pre-cancerous cells removed under a LA and although this was uncomfortable it was bearable.  I started to become very nervous indeed.  They said me on a chair with a bucket underneath and pumped water into me.  It was incredibly painful and uncomfortable with immediate effect.  They agreed to turn down the pressure and carried on with the hysteroscopy.  Apparently they couldn't get the tube in, so they had to give me a LA to my cervix to numb the area to use a speculam, but this still hurt.  I didn't want them to stop as I thought there was no alternative and I was scared of the possiblility of cancer, although I was in agony as they removed polyps with tweezers and took the biopsy.  By this time I was crying and yelling out with pain, but all they kept saying was "yes it's like period cramps, isn't it"  No it wasn't.  It felt like someone cutting into me and as if my womb was going to explode.  She kept saying there was just another one (polyp) she needed to get and yet when she had finished she said I would need a MyoSure procedure to remove the fibroids, which she assured me would be less painful.  Afterwards I felt shook and completely violated.  My husband was shocked when I told him and I stayed curled up at home for days, not wanting to speak to anyone.  I did complain straight away via email but it took months for them to reply.  In the meantime my MyoSure was cancelled.  I later found out that the nurse hysteroscopist had recorded my hysteroscopy as being 'well tolerated' by me!  This leaves me to believe that the actual statistics of people having a painful procedure may not be accurately recorded.  I was never offered any other kind of pain relief and don't want a GA due to my weight.  I was offered an apology, but the damage has been done and I'm terrified of ever needing anything like that ever again.

I attended a 2 week referral for post menapausal bleed stating I would require an out patient Hysteroscopy. I was not anxious despite knowing that it was to check for possible womb cancer. As the literature had described the procedure was like a smear test I had no concern. During the quick consultation I was informed biopsies were required but it would not be painful but may experience period like pain. 

The procedure started and a nurse was chatting away, hairdresser like chat, I thought it quiet irritating. I later discovered it is a distraction technique!! The consultant inserted a speculum, he then announced that the cervix was very tight considering I was only 2 years post menapause. Then I experienced the worst pain I have ever experienced in my life!! I felt faint, the room was spinning. I found myself trying not to vomit & breathed slowly to try not to pass out. I heard the consultant say " are you still in the room" I could not reply. The pain had been caused by the hysterscope passing through the cervix.

He was now in the uterine cavity and was filling the womb with saline, this was uncomfortable but bearable. Then he announced he was planning to take biopsies. He took 3 and with  each one I felt labour type pains, these continued for hours following the procedure and duller pains were experienced several days after requiring pain relief. 

Following the procedure he instructed me to get dressed and join him at his desk. I felt extremely shaky and was struggling to believe what I had just experienced! I negotiated myself around a bowl below the chair that was filled with saline and blood. I was quite horrified by this, what on earth had happened to me. The nurse passed me a sanitary pad and left me to dress.

I joined the consultant behind the screen once dressed, I believe I was in shock. I have no idea what he said and could not wait to get out of that room. The nurse returned me to the waiting room & said I could leave when I was ready.

I walked to the hospital entrance in tears wondering how I was going to drive home?? I figured it not safe, I was in tears and in pain. So I called my partner from work. I got home, went to bed and cried for several days.

Two years later, I experienced another PMB. I went to my GP dreading that they would refer me for another Hysteroscopy. When the GP confirmed this I just broke down in tears.

However the GP referred me too an alternative hospital within the Trust. They completed a vaginal ultrasound first & confirmed I would require a hysteroscopy. I informed the consultant that I would not agree to this in a conscious state. It was agreed that I could have a GA. This procedure went ahead within the 2 week timescale. I obviously had no pain during the procedure they removed a polyp &  I did not require any pain relief post op. Bleeding was also minimal. 

The literature for the original hysteroscopy was seriously lacking as was the consultants information. I do not believe I gave my informed consent on that occassion. To be honest the info for the 2nd was no better, it is just I had managed to inform myself and know my rights to request a GA.

My trust has now adopted the RCOG patient info leaflet. However not all trust are offering the full information. Until they do they are wilfully in breach of montgomery consent.

This has to change.

 

I had a hysteroscopy and have to say it was the most painful experience of my life. I was 65. I had been fitted into a cancelled appointment, for which I was grateful but this meant I hadn't received any information and didn't know what was about to happen.  I am not an anxious person and I'm not a wimp where pain is concerned. I delivered 2 children on gas and air, but I shouted out in pain and was reduced to tears both during and after this procedure and on occasion felt I was going to faint.  It was commenced without any anaesthetic or analgesia.  It soon became clear that my cervix was very tightly closed (evidently because menopause had occurred approx 20 years previously) and I was in excruciating pain as attempts were made to dilate it to gain access to the uterus.

Anaesthetic gel was applied to the cervix followed by a local anaesthetic. This procedure was far from pleasant and not without pain. (I didn’t know at the time that at least 10 minutes following administration was needed for this to be effective, but this time lapse didn’t occur and the procedure was started again almost immediately). Entry through my cervix was exceedingly painful, way beyond what would have been controlled by ibuprofen, and I felt I was going to faint.

Eventually access to my uterus was achieved and the polyp was in view. Then the saline solution was introduced causing a searing pain through my abdomen and up my side making me shout out and cry - it felt as if it was touching my ovaries! Because of the pain I was experiencing the water pressure used had to be lower than normal which meant that the biopsy sample was very small and there was a chance it wouldn’t be sufficient for the purpose. It wasn’t possible to remove the polyp as planned. During this time of unbelievable pain the two other nurses in the room were attempting to make light hearted conversation with me, presumably to distract me from the pain and to ensure I was still conscious!

At the finish I lay there and cried. I felt that I had been subjected to a barbaric procedure. I was escorted by one of the nurses to another waiting area where I was given tea and biscuits. She told me she was amazed I had managed to tolerate the procedure given the pain I was in.  I sat there until I stopped shaking and felt able to walk back to find my husband who took me home. I retreated under a blanket for the rest of the day in a state of shock having been totally violated by this abusive procedure.

The information, which I didn’t receive beforehand states "The procedure takes about five to ten minutes to complete..." Mine was much longer. Also "Before attending for the procedure it is advisable to have eaten breakfast/lunch." Luckily I hadn't as I'm sure I would have been sick. Also "taking Paracetamol or 400mg of Ibuprofen one hour before the procedure will help to alleviate any cramping pains that can be experienced during and after the procedure. You do not require any anaesthetic for the procedure, but you should bring someone with you who can drive you home." I didn’t experience cramping pains. I experienced the worst pain of my life!  This pain would not have been controlled by over the counter meds!

As the polyp hadn't been removed in the end, I had to return for a GA procedure.  I couldn't face returning to the same hospital and had to be referred elsewhere.  This procedure was like a stroll in the park, with only mild cramps for a few minutes when I came round from the anaesthetic and fully recovered in a couple of hours.

How dare they say that all women prefer OP procedures.  Are all women saying they prefer excruciating pain?  No other painful endoscopy procedure is carried out without anaesthetic/sedation being offered.  It smacks of gender inequality and an assumption that because women experience childbirth they can bear any kind of pain thrown at them.  I understand its between 25% and 30% of women experience severe pain.   I am so angry that this happened to me and is still happening to other women on a daily basis. It's a scandal!

Thanks for giving space and time to this appalling procedure.

 

there are very few places that do it well Sheffield is meant to be very good the problem is if hysterscopys were stopped at a appropriate pain level it would result in at least %25 failer rate in diagnostic and about %35 in operative and that is being generous the fact that it loses hospitals money  to do them in theater means they want to put patients trough they know are not suitable i will say Kingston in London has made big improvements after a complaint and have resonantly done a great patient information leaflet witch i helped with which i have linked . but there needs to be a end to best practice tariff increase for theater and most importantly sedation the biggest thing currently affecting outpatient hysteroscopy is no one is being the patients advocate and stopping when it obviously needs to again to be fair to kingston they have a new team and are told to be patients advocate

A0043 Hysteroscopy Leaflet.pdf

1 hour ago, Claire Cox said:

Really sorry to hear this.   There must be places that do this procedure well.   It would be fantastic to hear about what ‘gold standard’ is and ensure all women have this same standard of care. 

A lot of OPH cases are for women who are ultimately there to have cancer diagnosed or ruled out - why in earth is the NHS putting women, who are already terrified, through this barbaric procedure? 

1 hour ago, Claire Cox said:

Really sorry to hear this.   There must be places that do this procedure well.   It would be fantastic to hear about what ‘gold standard’ is and ensure all women have this same standard of care. 

I'm sure there are good experiences,  but the issue is nationwide, certainly not specific to one or two trusts. Leaflets (if they are issued) are often inaccurate, with no mention of severe pain. A woman cannot make an informed choice about her procedure if she isn't in full possession of the facts and is lied to. This is not Montgomery compliant practice and should be investigated immediately 

PMB  women should not be referred to outpatient hysteroscopy they are the most at risk of pain vomiting fainting. the NHS get away with this because they use the fear of Cancer to do it on the cheap. it is a clear disregard for duty of care

My GP kept delaying referring her patient with womb cancer symptoms for hysteroscopy.  When I finally asked why I wasn't being referred, she explained, "you'd freak out at an NHS gynae clinic".  She knew what experience a childless woman with severe dysmenorrhea could expect.  She told me a general anaesthetic would cost me over a £1,000.  I fought hard over several months and countless medical appointments to be allowed an NHS GA which showed  stage 3c womb cancer.  Fantastic NHS surgical care & masses of radiotherapy worked.  In the local Macmillan gynae cancer support group I help run - over the last 7 years I've yet to meet a woman who had anything other than a 'brutal' outpatient hysteroscopy.  Yes - throughout the NHS some women do have excellent experiences but most clinics are staffed by under-skilled or over-confident operators,  under pressure to perform hysteroscopy as quickly and cheaply as possible.  Yes - there are slighter higher risks when hysteroscopy is performed under GA.  So we need the NHS to fund, train and safely resourced and monitored procedural IV sedation with analgesia for hysteroscopy.  It exists in Sheffield, Newcastle and a few other hospitals.  This would bring the patient experience of endoscopy of the womb in line with endoscopy of the colon, stomach etc.  It would give women the option of having a pain-free and relatively stress-free experience.   We need CHOICE of pain-control according to a woman's preference and medical need.  Not just 'Trial by Outpatient Hysteroscopy' with 'vocal-local' hairdresser chit-chat then tea and biscuit for shock.  Thank you Patient Safety Learning Hub for listening to an all-too common story. 

 

To read some more horror stories from the Care Opinion website demonstrating the lack of safeguards in NHS outpatient hysteroscopy go to: https://www.hysteroscopyaction.org.uk/wp-content/uploads/2018/10/sept-2018.pdf There's also an essay on 'How the NHS gets away with torturing 1 in 4 women'.  

It's great the hospitals are highlighted in the link- In one story the patient did not know the people in the room- This is poor  practice! Everyone in the room should be introduced to the patient- This is part of protocol and if not followed, is  also disrespectful.

The staff at the independent Care Opinion site completely independently of the Campaign Against Painful Hysteroscopy did their own pictorial analysis of the hysteroscopy stories they received.  They concluded the main problem was: PAIN. 

 

29 minutes ago, Kathy Nabbie said:

It's great the hospitals are highlighted in the link- In one story the patient did not know the people in the room- This is poor  practice! Everyone in the room should be introduced to the patient- This is part of protocol and if not followed, is  also disrespectful.

The only person I 'knew' was the doctor who had, a few minutes earlier, lied to my face about the likelihood of severe pain 

The pain was horrific, indescribable. I’d had no information from the hospital so no idea what to expect. Didn’t seem odd – I assumed what was being done was nothing to worry about.

When “biopsy” was mentioned, alarm bells rang. I’d had one years earlier and never forgotten it, it was awful. I asked about pain but was reassured by the hysteroscopist over and over again, so I went ahead. I had injections into my cervix. It was agony. I thought, well (a bit like at the dentists’), that’ll be the worst of the pain over and worth it to make the rest of the procedure painless. I couldn’t have been more wrong. Devices were pushed through my cervix, then fluid flowed into my uterus. This was incredibly painful, I didn’t think it could get any worse but then biopsies were taken. I could literally feel my insides being cut away with absolutely no pain relief. All of this took a long time to do.  I was trying as hard as I could not to scream. The nurse next to my head just started chattering at speed, talking rubbish really. Found out later this was my anaesthetic – the “vocal local”.

The pain made me feel sick, I managed to get the words out and I was brought a tiny, shallow bowl. In the back of my mind I was thinking, if I vomit all over my shirt, I have to get home like that! I had come on public transport, as I had no idea of this was going to be done to me. I was close to blacking out. A familiar feeling as all my life I’ve had severe period pain that did the same – except this pain was many times worse.

It seemed to go on and on. I was panicking. Kept thinking, if I tell them to stop, I’ll have to come back and have this done all over again and I know I can’t endure that. I need to know whether I might have cancer, I have no choice but to suppress my screams and carry on. Compare it to part of your body held over a flame. How long could you endure that? That’s just how I felt.

Eventually it ended. My legs were like jelly, I felt dizzy. No one cared. I was struggling to comprehend, if there should be NO pain, why was no one worried by how I reacted? Eventually managed to get to my feel and hobble to a side room to get dressed. Told there were sanitary pads (hadn’t brought anything but thin liners as I had no idea!) it didn’t even have adhesive. I now had to get home on public transport terrified I’d bleed through my clothes. I cannot describe how violated I felt. Eventually got dressed and out of the clinic I could hardly walk. It took me a long time to get home and I fought back tears all the way. I have had flashbacks ever since.  In telling my GP, I was so upset she suspects I have PTSD.

To be able to look at the uterus is a good tool but was shocked at how it was done. Throughout I struggled to believe what was happening to me. I kept thinking this CAN'T get any worse and then it did. Much later I found out about guidance that RCOG have published about this procedure. I know I was never a candidate for having this done in outpatients. The staff must have known that. I was conned and left with long-term damage as a result. I have read other women saying they now cannot even return for cervical screening. I haven’t had to yet, but will see when the time comes. I hope I am feeling stronger by then. I can't see me EVER going back to the same hospital unit though, no matter what.

The Department of Health and the British Society for Gynaecological Endoscopy (BSGE) are heavily promoting outpatient hysteroscopy.

The Dept of Health's long-standing Best Practice Tariff incentivising OP hysteroscopy has meant hospitals have stopped investing in theatre places for hysteroscopy.  Women who ask for GA hysteroscopy go onto a long waiting list.  

Despite the Campaign Against Painful Hysteroscopy's work to give patients their 'Montgomery' legal right to informed choice, and also to improve patient selection and pain-control in outpatients, the Dept of Health continues to hype OPH. 

The attached file is of a workshop to encourage gynaecologists to 'kickstart' outpatient hysteroscopy services on the basis of 'patient feedback'.  

Hmmm.   The Dept of Health and many of the BSGE's hysteroscopists are ignoring or downplaying the excruciatingly painful OPH experienced by far too many patients throughout the NHS.  

https://www.sbk-healthcare.co.uk/home/title/2428/nhsconference/updating-and-adapting-outpatient-hysteroscopy-(oph)/?fbclid=IwAR1mgXi4QXIe8OjJOHiYRBouFpWx6QCdcHPniVTMBnx7GRKAQYkHa5-X5XY

https://www.gponline.com/refer-women-heavy-menstrual-bleeding-hysteroscopy-nice-says/womens-health/menstrual-disorders/article/1459586

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6501119/

Endometrial/uterine Biopsy
October 2019

Following the discovery of a cyst on my ovary and raised Ca 125 blood levels…I was put on the ‘2 week urgent referral pathway’ to my local hospital. I have to give credit for the speed from my doctor’s referral on the Thursday, the hospital rang on the Friday appointment letter received on the Saturday and I was seen on the Monday.

Attending with a full bladder (as that’s what my letter instructed – it had even been underlined in pen) I spoke with the Dr, thankfully she assured me from the scan taken previously she wasn’t overly concerned anything sinister was going on, and wasn’t too concerned regarding my raised Ca 125 levels, so there was no need for another scan however she would like to do a pelvic exam so I could go and empty my bladder.

Having had a few pelvic exams in the past I wasn’t concerned at the thought.

I lay on the table, nurse to my right – doctor to the foot of the bed,

In went the first tool, I wasn’t quite expecting that for a pelvic exam – knowing I had to go through some tests because of suspected cancer I let her continue…another ‘tool’ came out which looked like a long plastic tube –  she poked and poked and poked some more, until painfully she made her way through my cervix…at this point I was emotionally and painfully numb and confused, however in the confusion I knew in my mind a biopsy had to be done (and assumed that this was happening, right here right now without prior warning) she somehow twisted this long plastic thing she had forced through and up my cervix. I was actually still unsure if this was part and parcel of some ‘different type’ of pelvic exam! gripping the sides of the table hard and hardly able to speak she twisted and poked again and again…. The nurse asked if I was OK, I faintly nodded and said through gritted teeth ‘It’s got to be done’ the nurse looked at me and faintly nodded …. more seconds passed, nurse gently placed her hand on my arm and gave me some breathing directions – Doctor said nearly done but I can stop anytime you want! and then procedure complete.

The doctor was kind – the nurse was lovely… however...

Still traumatised by the experience but trying to put on a brave front – the doctor looked at the nurse as she was putting the collected sample in some type of fluid container and said ‘it was because it’s been 15 years’ I can only assume she meant since I gave birth therefore my cervix was tight/closed.
Nurse left to go and get something that looked like a giant cotton ear-bud the doctor had asked for to help soak up some blood, while she was gone I looked at the doctor and said OK I couldn’t ask before as during the procedure as I simply wanted to 'get it done' (in other words I didn't want to have gone so far.. stopped the procedure...and have to have it done again or restarted) but exactly what have you just done….and it was only then I had confirmation I had had a biopsy done….I have no recollection what-so-ever of having this discussed with me prior to the procedure – I was asked about past history, vaginal births, symptoms and if my smears are up-to date – I was asked if I suffered with water infections, allergies, any bowel issues and contraception.  I can recollect pelvic exam being mentioned and it was at that point I went to the toilet – on arrival back it was right in the room for exam.

I was offered no pain relief; I didn't even get chance to have pain-killers before leaving home as I didn't know this was on the cards....in all honesty, I didn't even realise this procedure was done in the consulting room/doctors’ office! I had no information on the process or what could go wrong during or after.

The nurse left me a packet of menstrual pads on the side and some tissue to sort myself out.

Once back in the office the nurse stayed with me while the doctor went away to speak with someone else the nurse chatted and asked if I was OK now, said I could have some pain-killers when I got home and if I was OK - I said yes as at that point I was - relieved it was over.

The Dr came back – said the person she spoke to wanted to repeat my CA 125 bloods in 4 weeks time – she mentioned coming back for a hysteroscopy (nurse passed me a leaflet) and possibly look at Nova Sure for my heavy bleeding (nurse passed me another leaflet) she booked me in for the bloods and appointment for hysteroscopy would follow…as I was leaving I said how long will the Biopsy results take, I was informed 2 weeks.

I went home.... I bled heavily and cramped for 6 days – the week following I had excessive watery discharge - had sleepless nights and still do...it still plays on my mind...

This is an awful procedure to endure and shouldn’t be sprung on women without their full undivided attention and consent, I have given birth vaginally on just gas and air and by no means an emotional wreck when it comes to pain and discomfort I have endured more than my fair share of intimate examinations – I can however say this was one of the most traumatic, painful moments of my life.

While I repeat – the Dr and Nurse were lovely and I’m sure ‘just doing their job’ but I do not have any recollection of this procedure being discussed with me beforehand, I was given no leaflet prior, no option of pain-relief and no information on any possible risks during or after procedure.

Once home I started to re-search for myself and found many other women who had suffered similar experiences during biopsies and hysteroscopies :( You are at the time made to feel there is no other option and it has to be done this way, I've since found out this just isnt true.

I had one 3 years ago and found it very painful. No sedation was offered. I've got an appointment for another later this month and some info I got this time was to take Ibuprofen an hour before the appointment. The pain I felt last time won't be stopped by Ibuprofen,.. I phoned the Oncology nurse who said only if it proves too painful will they stop it and arrange for a general anesthetic for it... My point here is,, it in my opinion should be made an option right from the start. I obviously don't want any delay in a diagnosis and why once again I don't want it deferred till they can offer anaesthetic... but I'm absolutely dreading it.. Last time I thought I might burst a blood vessel the pain was so bad I think it a dreadful state of affairs for this proceedure not to have some sedation.

Hysteroscopy patients have a right to ask for general anaesthetic upfront but under-resourced NHS clinics are coercing women into attempting 'Trial by Outpatient Hysteroscopy' first.  One patient describes this as  'torture by nice people'. 

I was totally mislead before my outpatient hysteroscopy to investigate PMB under the 2WW.The patient information leaflets said discomfort ,cramp/pains and like a smear test. I wasn’t screened just told the lining of my womb was to thick I need to have a look with a camera. A folded  up consent form was pass over the desk for me to sign I was warned of infection, perforations, a lot of water and most women tolerate it. Not being medical I  didn’t really understand.

This turned out to be the most horrendously painful experience of my life. The pain was so overwhelming I couldn’t shoutout no one was observing/ supporting me top end of the table. I was sweating my legs were twitching pain shooting up to my neck I felt sick then a burning all over my body.

The nurse assisting the Dr did eventually stop the Dr.

Only after was I told  that GA even a possibility.

No recovery area.

I’ve had counselling CBT and dream intervention therapy still get nightmares 

HYSTEROSCOPY, BIOPSY & POLYP REMOVAL (Part 1)

First of all I was taken into a room where the consultant quickly looked at my file and I was asked to sign the consent form.  Very little discussion took place.  I was to have a hysteroscopy to check for cancer of the womb. A biopsy was mentioned and also the fact that I had a polyp.  I knew about the polyp because it had been found in 2010 during a previous hysteroscopy.  The consultant at that time saw no reason to remove it and I believed that it would be left again as I had no symptoms.  No options were discussed. I felt scared and vulnerable.   
I was taken into the treatment room and I sat down and started to weep.  I was trying to keep calm and be brave.  One of the nurses asked me what was wrong.  I said "I have had womb biopsies done before and I know how painful the procedure will be"  She replied "Oh then there's not much we can say then".  I was shocked at her reply.  It was confirmation to me that everyone knew what was about to happen! The consultant observed that I was crying and asked if I would like to come back another day.  I couldn't understand the logic of that because this procedure was going to hurt, without a doubt, on whatever day it was done.  I had taken 3 types of pain relief instead of the suggested paracetamol.  I took 2 paracetamol, 2 ibuprofen and 2 codeine (from a friends prescription) so I could give myself the best chance of coping.
So, the procedure got under way.  I felt the scope pass up through my cervix. It was uncomfortable. The consultant was looking at what she was doing, did not have any conversation with me and the nurses were across the room.  I was managing to keep myself calm at this point.  Suddenly, without warning, I felt pain. I screamed. I was embarrassed and upset. I guessed that a biopsy had been attempted.  The consultant got up and walked to the other side of the room.  No acknowledgement of my pain, no explanation. Her back was towards me and she was talking to a nurse.  I had no idea what was happening. I felt excluded, vulnerable and I wondered what she was saying about me.  Eventually she came back and said "I don't think the sample will be sufficient"  She sat down to start again but immediately got up and started to walk away.  I looked at her enquiringly.  She said "you've gone into spasm".  I felt like it was an inconvenience to her. She went back over to the nurses.  When the consultant started again I expected more information and dialogue but there wasn't any.  I thought she may enquire if I was ok to try for another biopsy but instead, without telling me, she decided to start the polyp removal.  The pain was getting worse. I asked if I could have some pain relief. She replied "I can give you an injection into your cervix".  I asked if that would stop the pain in the womb where she was cutting".  She said "no".  I declined as there was no point in having more pain to deal with when it would have no effect.  I had lost all control over what was happening to me.  I did not know what to expect next.
By now I was reaching the top of my pain threshold. I was becoming very distressed.  There was still no discussion, no one asked if I was ok to continue and the nurses were not near me or giving me any support. I could not continue enduring the horror. I remember thinking I have got to physically move away from the pain source but then I thought, but I can't because the instruments might puncture my insides. What happened next was very strange. I experienced staring at the consultant but her face looked cloudy.  The pain stopped apart from an acceptable but odd and less intense pain across my pelvic region.  Then I felt totally relaxed and the fear had gone.  I had dissociated.  For a few blissful seconds I was ok.  Unfortunately, the nurses came running over and one said my name.  They took my hands.  I panicked because I thought that they were going to hold me down.  I submitted.  I was instructed to count and breathe.  The pain was terrible.  I dare not stop the breathing.  I was taking as much air in as I could and consciously creating pain in my chest to try and block some of the pain from my pelvic area.  Still no one was talking to me. (Apart from the breathing instructions) I had no idea how long I would be enduring the pain.  Finally the consultant said "I'm finished".
At this point, I was really in shock and was shaking uncontrollably.  The consultant came over and tried to show me the polyp.  She seemed excited that it had a long stalk.  I looked at her in disbelief. She said "Oh I don't suppose you want to see that, do you". When someone has just been through a terrifying and painful ordeal, why on earth would you show them the flesh that you had just cut out of their body.  I was horrified.  The consultant left the room and I did not see her again.
I was so scared I dare not sit up.  The nurses were not paying much attention to me but then one noticed that my private parts were still on show.  She said "cover yourself up".  I did not feel human any more.  I did not respond so she came and covered me.  I was then expected to get up quickly, get dressed and get out ready for the next patient.  My legs were so shaky I feared standing up in case I collapsed.
I managed to get dressed.  I could not believe what had happened to me.  They fetched my husband to take me home.  They told him that I had worked myself up into a state and he felt that this indicated it was caused by my anxiety and weakness.  I could not go to the car park straight away.  I felt dreadful. I was fearing walking back through the waiting room. We were ushered into a room across the corridor where my husband and I sat for about half an hour before I could risk walking to the car.  This was not a room that was designed or fit for patients to recover.  I felt as if I had suffered a violent sexual attack.  I was totally stunned. 
This post is quite long so my next post (Part 2) will give an account of what happened next.
 

THE AFTER EFFECTS (Part 2)

SUFFERING AND FINANCIAL LOSS OVER 3 YEARS
I am including this information in the hope that it will reinforce how much suffering and loss can be caused by subjecting women to such excruciatingly painful practices, during gynaecological procedures. The woman that leaves that room is not the same woman that went in.
The patient leaflet said I would be able to return to work the next day.  I went to work but my sister had to collect me at lunch time and take me home.  I had some internal pain and felt pulled about.  Mentally, I could not function.  I was still in shock and crying.  My sister attempted to comfort me and I said "how can they do that to a human being?"
I had the Bank Holiday to try and recover.  I am not the sort of person that takes time off sick.  I was mentally wrecked.  I could not cope with what had happened to me.  I felt as if I had been attacked.  It kept going over and over in mind.
On the 5th morning after the procedure I tried to get ready for work.  I got into the shower and all sense of time seemed to disappear. It is possible that I dissociated again.  I remember leaning against the wall in the shower thinking I just can't, I just can't.  Something was seriously wrong with my mind.  I kept trying to get ready for work but had a massive panic attack.  It was very scary.  I had never experienced one before.  I had to see my GP.  She prescribed Propanalol to calm me down. I was given the number for NHS counselling but the wait was around 6 weeks.  A friend recommended a private therapist and I had my first appointment 3 days later.  I eventually went back to work with the help of therapy.  I was however, signed off sick for 8 weeks.
I remained on medication for 4 months.  I started to feel better and thought I had moved on.  Things were fairly good initially, but gradually the intrusive thoughts returned.  I was suffering from PTSD/trauma.  I did not expect to be lying in bed 2 years later, unable to sleep, crying, reliving the trauma and holding my body rigid. I attended 6 counselling sessions at my GP surgery.  These were helpful but did not solve the problem.   I learned about EMDR therapy to treat PTSD. There was a long wait so I sourced it privately.  I could not carry on like that. I couldn't concentrate on normal life.  I wasted so many days.  A lot of time was spent crying.  I have had a lot of trauma counselling over the last 8 months which should finish soon.  I cannot erase the memory but I am trying learn to live with it.
 My financial losses (unpaid time off work, therapy costs, travelling expenses etc) amount to several thousands of  pounds which I will not get back. 
 I will not be able to look after my health properly in the future.  I have never missed a cervical smear in my whole life but I will never be able to have another one.  I couldn't cope with the fear of any future procedures.  This is a big disadvantage and a worry because my Mother died from ovarian cancer.  I am not a wimp.  I have had 2 children, surgery and many other biopsies.  Apart from a thyroid biopsy all other biopsies were done with appropriate pain relief. My husband has to come with me on medical appointments now as each one raises my anxiety levels. I will never forget the terror and pain of that hysteroscopy. Mental health is as important as physical health.  It's shameful that mental well being is ignored.
 I believe that operating within the womb without adequate pain relief should not be done.  I know now that I am not that unusual to have experienced out patient hysteroscopy as traumatically as I did.  It happens to women every day.  Knowing that I am not alone in this has probably saved my sanity and is helping my recovery.  I do however remain in a state of disbelief that anyone can condone this practice. 
 

I was so lucky to have my hysteroscopy and polypectomy under GA. I had a consultant who recognised that I was at risk of suffering severe pain (not had a baby, a history of anxiety and painful periods) and told me so at my initial consultation. But supposing she hadn't been so honest? Most women are not given this information and cannot therefore give informed consent. 

This is an invasive and painful surgical procedure that should never have been taken out of the operating theatre, IMHO. Even if some very experienced doctors claim to be able to do a hysteroscopy with minimal discomfort, this is meaningless when you consider that most hysteroscopies involve surgery at the same time (e.g. cutting out of polyps or other masses) and patients should not be expected to undergo this awake and without strong pain relief.

Perhaps in the future they will be able to do it painlessly in an outpatient setting, but it should be obvious to anyone with experience of this procedure that we are far from being at that point.

Under GA it was quick, painless and I was back on my feet within a few hours. The women in the same room as me who'd had the same procedure without anaesthetic were all obviously traumatised and in pain long after they had been in recovery. This is a false economy and we can't allow it to go on just because women don't get listened to.