My first experience of hysteroscopy was with a consultant gynaecologist who was trialling the use of the procedure in a theatre connected to the OPD. I had had one (thankfully very brief) previous attempt at inserting a Mirena for dreadfully heavy bleeding, when the Dr said that my cervix was stenosed. I had no previous vaginal delivery and one Caesarean section which I am told can contribute.
I was fully informed about the procedure (insertion of Mirena & biopsy) by the consultant and told that I could stop it at any time if I wished. I think he must have been really generous with the local anaesthetic and I tolerated it OK although I did say in the feedback that it was the limit of what I could bear. Importantly, he told me that my cervix was really narrow and said that I might “need to go to theatre” to have it removed as “it’s probably going to be tricky to get it out”.
The Mirena wasn’t a success for me but I couldn’t get anyone to take my complaints seriously. It felt uncomfortable from the outset, at a “stone in the shoe” level. I had period type cramp most days while it was in place, but the Practice nurse & GP both shrugged it off despite repeated visits.
It didn’t solve the problem it was inserted to treat either. I swapped periods lasting a week with several unmanageable days each month, for bleeding almost continuously, stopping for an occasional but completely random day. And the discomfort....
Around 8 years later I ended up back in the same gynae department, being investigated for post menopausal bleeding. The coil was still in situ as the GP had finally agreed that it could remain rather than have it removed when it was no longer active.
Vaginal USS had suggested that I had a uterine polyp, and I arrived at the clinic expecting to discuss next steps. I was seen by a middle grade doctor who said he wanted to try to get the polyp out there and then (on a narrow examination couch with a wall mounted angle-poise lamp so uncomfortable and awkward). There was nurse in the room but I don’t recall her doing anything apart from hovering in the background.
I reported the concerns of the previous consultant re needing to have it removed in theatre but he persisted and I submitted to an attempt to perform the procedure. He tried to grab my cervix with what I now know to be a tenaculum and attempted to get through the cervix. It was excruciating. His manner was dismissive as though I was making a fuss although I had always been fine having smears/examinations in the past. He reluctantly arranged for me to go to the Women’s Health Unit, where they did colposcopy etc, a few weeks later so that I could have a local anaesthetic.
I assume the trainees need to perform a certain number of procedures during their training and I felt that he completely dismissed what I said in order to “tick one off”.
I was sent for another ultrasound but apparently the coil was distorting the imaging and I was told to get it removed. This ended up being in a community family planning clinic as the practice nurse had left and there weren’t suitable GP appointments available in the near future (and there was a possibility of a cancer diagnosis in the offing). Again I repeated what the consultant had said about potential difficulty in removing it. It was a female dr who seemed reassuring enough so I let her carry on. She suddenly said “1,2,3” and then repeated it. At no time had she explained that on “3” she wanted me to do anything but apparently I was expected to cough. I have a long career in nursing and have carried out hundreds of procedures/manoeuvres “on a count of 3” but she didn’t explain and simply wrenched out the coil. It did come out but it was incredibly painful, caused bleeding for several days and I needed days off work afterwards.
So after a repeated scan I returned to the Women’s Health Unit. A female consultant this time who was at least a bit more sympathetic. HCA assisting was “business like” rather than reassuring. The procedure was difficult “because the cervix was so narrow!” but biopsy was done. The “polyp” had miraculously disappeared when the Mirena was removed funnily enough. The consultant was ok, and with generous anaesthetic I just about tolerated it, though she said at the end that, if I ever needed a repeat, I could have sedation. This is against a background of regular pain relief that I take for chronic conditions.
After the procedure I got changed, and left the department. I have never been so glad to have my partner with me as I felt lightheaded and shaky for the rest of the day.
The procedures/attempts were bad enough and I didn’t feel that I was listened to or taken seriously by any of the medical staff after the first consultant who inserted the coil. But much, much worse was the refusal to take on board the “message” that the consultant told me to pass on to future staff. All but the Family Planning clinic were part of the same trust and the first consultant was well known in the department though no longer working. As a health care professional I can usually advocate for myself; I dread to think how they treat women from other backgrounds.
And as for the trainee who insisted on attempting the hysteroscopy in OPD, I hope he has changed his approach and manner. He’s probably a consultant somewhere else by now, still torturing patients.
