Summary
In this blog,0 Stephanie O’Donohue, patient advocate and Founder of TIGER UK, shares the findings from their recent survey on experiences of vaginal access procedures.
She explains why patient experiences and insights are critical to service improvement, and how collaborative work can really make a difference moving forward.
Content
If we want to improve experiences of gynaecological care, we need to understand what those experiences are really like for patients. Not just the clinical outcomes, but how people feel before, during and after procedures, what influences their experiences, and what matters most to them.
This is central to the work of TIGER UK (Together Improving Gynaecology Experiences and Research), a not-for-profit organisation I founded in 2025, built on the belief that meaningful progress comes through collaboration and combined insight.
Our first survey exploring experiences of vaginal access procedures is an important part of that work.
The value of patient insight
Developed with input from patients, clinicians, researchers and others with relevant expertise, our UK-wide survey received 706 responses from people who had undergone vaginal access procedures without general or spinal anaesthetic.
We wanted to deepen understanding of these experiences, identify factors influencing them and, importantly, gather insights that could help inform improvements to care.
The first report of our findings has now been published, sharing mostly quantitative data, and how common certain experiences were among respondents.
These findings highlight some significant challenges, but also clear opportunities to make a difference.
The experience often begins long before the procedure itself
71% of respondents told us they feel differently before a vaginal access procedure compared with other healthcare appointments.
A further 16% said they sometimes do.
When we asked people to describe those feelings, the most frequently mentioned words included:
anxious
nervous
embarrassed
apprehensive
worried
scared
vulnerable.
This matters because how patients are prepared and supported needs to reflect the emotional as well as physical aspects of care.
Pain, preparation and consent
Nearly six in ten respondents (59%) reported having experienced severe pain during a vaginal access procedure.
Of those who experienced severe pain, 47% did not feel appropriately supported by healthcare staff. And among those who had been warned about possible pain, 62% said the description they received did not reflect its intensity.
These findings raise important questions about how patients are prepared, and how distress is both recognised and responded to. These aspects of care can have a huge impact on how safe someone feels.
Consent and control are equally important.
44% said they had always felt able to stop a procedure but more than a third of respondents (36%) said they hadn’t.
Consent should be continuous and goes beyond what is written on a form. It needs to be communicated through the conversations, and care people receive. Patients need to know they can stop or pause, and feel able to exercise that choice, with confidence that their wishes will be respected.
When the unexpected happens
50% of the respondents had experienced something unexpected during a vaginal access procedure.
The experiences people described included:
very high levels of pain
additional tests or procedures
difficulties completing procedures
equipment issues
who was present
staff attitudes or behaviours
and physical reactions such as fainting or vomiting.
Not everything that happens in healthcare can be predicted. But good preparation and communication is key to upholding patient choice and autonomy. Many of the examples shared through the survey could have been communicated beforehand. Some were less predictable. Some should never have happened.
Individualised care matters
Accessibility was another important theme.
Nearly one in five respondents (19%) said they needed, or sometimes needed, additional support, adjustments or considerations to attend vaginal access procedures.
The support, adjustments or considerations that people described related to a variety of things, including:
physical accessibility
neurodivergence
previous trauma (eg sexual, medical)
pain management
information and communication
comfort (e.g. speculum size, positioning)
medical conditions or symptoms (eg lichen sclerosis, vaginismus, vaginal atrophy)
anatomy (eg tilted cervix).
43% of those respondents said their needs were sometimes met. Around a third (34%) reported that their needs were either never or rarely met. Nearly a quarter (24%) reported their needs were always or often met.
Person-centred care includes creating opportunities to discuss individual needs, recognising differences, and adapting care accordingly. Sometimes a seemingly small adjustment can make the difference between someone feeling unable to access a procedure and feeling able to participate in their care.
Why experiences matter beyond the appointment
This may be one of the most important findings in our report.
35% of respondents said previous experiences of vaginal access procedures had made them less likely to attend future appointments.
Just over half said their experiences had made no difference, while 13% said they had made them more likely to attend.
A healthcare experience doesn't necessarily end when someone leaves the room. It can influence whether they feel able to return next time. These procedures are used for essential investigations, screening and treatment, so reduced engagement with future care has potentially important consequences. Improving patient experience isn't therefore simply about making one appointment better. It's also about building, and rebuilding, trust in healthcare.
Moving from insight to action, together
We recognise the immense pressures healthcare professionals face, and we want to contribute to solutions.
Our first report focuses largely on the quantitative findings but a second will explore patients' written responses in greater depth, looking at what shapes both positive and negative experiences, alongside recommendations (register for updates).
Listening to patients is how we begin to understand what needs to change.
We want to make sure the patient insights captured in this work are used to help shape conversations, challenge assumptions, inform research and guide practical improvements - collaboration is fundamental to TIGER UK's approach.
Through our free Network, we continue to bring together patients, healthcare professionals, researchers and advocates to share perspectives, learn from one another and identify opportunities for progress.
Stay connected and get involved
About the author
Stephanie O'Donohue is a communication and engagement specialist and has worked in the health sector for 20 years. Her professional and personal health experiences led to her passion for patient advocacy and women's health. She contributes insights through lived experience consultancy and as a patient author for the BMJ. In 2025, Stephanie Founded TIGER UK - facilitating collaborative conversations around gynaecological healthcare to improve patient experiences.
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