In my opinion, there is a clear balance that needs to be addressed. The frequent use of hysteroscopy is an important clinical target, with multiple diagnostic benefits, especially regarding serious conditions wherein early diagnosis is important for beneficial clinical outcomes. It is also clear that the NHS has severe financial pressures, with this worsening year on year (not even mentioning Covid). Lastly, avoiding the use of general anaesthetic and sedation have benefits for patients, healthcare providers and the reduction of risk.
However (and this is a large however), all of these benefits do not excuse the continued ignoring of a serious problem impacting a large proportion of women that undergo hysteroscopy. As a man, this is a trial I will never have to undergo. But the well-articulated reports I've read from women who have experienced intolerable pain and instances of remarkable absences of empathy are beyond troubling. Outside of my interest in hysteroscopy, my research focuses on pre-surgical pain assessments, and I am attempting to identify mechanisms that may indicate vulnerability to pain. My ambitions are the development of methods to stratify patients into risk categories for pain. It is clear that some women experience no pain or discomfort during hysteroscopy, where some experience the worst pain of their lives. If we can develop methods to cluster these patients before the procedure, then we could hopefully limit the frequency of this serious problem.
However, until we can do this, it is unethical and inappropriate to advertise the procedure as being pain-free or low-pain, when my research indicates this is true in less than 10% of cases. Pain has an ability to leave an indelible mark on our characters, memories and self-worth. Medically, hysteroscopy represents a diagnostic procedure which much benefit, and it is crucial that women are not traumatised and scared off for life. The current National protocol requires an entire revamp, and I am very pleased to encounter so many campaigns raising awareness and fighting the battle on behalf of those who, otherwise, may find their voice is not loud enough to be heard. This was an excellent article, and I wish the Patient Safety Learning group and disenchanted hysteroscopy patients all of the best in their pursuit of change.