Jump to content

Search the hub

Showing results for tags 'Obstetrics and gynaecology/ Maternity'.


More search options

  • Search By Tags

    Start to type the tag you want to use, then select from the list.

  • Search By Author

Content Type


Forums

  • All
    • Commissioning, service provision and innovation in health and care
    • Coronavirus (COVID-19)
    • Culture
    • Improving patient safety
    • Investigations, risk management and legal issues
    • Leadership for patient safety
    • Organisations linked to patient safety (UK and beyond)
    • Patient engagement
    • Patient safety in health and care
    • Patient Safety Learning
    • Professionalising patient safety
    • Research, data and insight
    • Miscellaneous

Categories

  • Commissioning, service provision and innovation in health and care
    • Commissioning and funding patient safety
    • Digital health and care service provision
    • Health records and plans
    • Innovation programmes in health and care
    • Climate change/sustainability
  • Coronavirus (COVID-19)
    • Blogs
    • Data, research and statistics
    • Frontline insights during the pandemic
    • Good practice and useful resources
    • Guidance
    • Mental health
    • Exit strategies
    • Patient recovery
  • Culture
    • Bullying and fear
    • Good practice
    • Occupational health and safety
    • Safety culture programmes
    • Second victim
    • Speak Up Guardians
    • Staff safety
    • Whistle blowing
  • Improving patient safety
    • Clinical governance and audits
    • Design for safety
    • Disasters averted/near misses
    • Equipment and facilities
    • Error traps
    • Health inequalities
    • Human factors (improving human performance in care delivery)
    • Improving systems of care
    • Implementation of improvements
    • International development and humanitarian
    • Safety stories
    • Stories from the front line
    • Workforce and resources
  • Investigations, risk management and legal issues
    • Investigations and complaints
    • Risk management and legal issues
  • Leadership for patient safety
    • Business case for patient safety
    • Boards
    • Clinical leadership
    • Exec teams
    • Inquiries
    • International reports
    • National/Governmental
    • Patient Safety Commissioner
    • Quality and safety reports
    • Techniques
    • Other
  • Organisations linked to patient safety (UK and beyond)
    • Government and ALB direction and guidance
    • International patient safety
    • Regulators and their regulations
  • Patient engagement
    • Consent and privacy
    • Harmed care patient pathways/post-incident pathways
    • How to engage for patient safety
    • Keeping patients safe
    • Patient-centred care
    • Patient stories
  • Patient safety in health and care
    • Care settings
    • Conditions
    • Diagnosis
    • High risk areas
    • Learning disabilities
    • Medication
    • Mental health
    • Men's health
    • Patient management
    • Social care
    • Transitions of care
    • Women's health
  • Patient Safety Learning
    • Patient Safety Learning campaigns
    • Patient Safety Learning documents
    • Patient Safety Learning news archive
    • 2-minute Tuesdays
    • Patient Safety Learning Annual Conference 2019
    • Patient Safety Learning Annual Conference 2018
    • Patient Safety Learning Awards 2019
    • Patient Safety Learning Interviews
    • Patient Safety Learning webinars
  • Professionalising patient safety
    • Accreditation for patient safety
    • Competency framework
    • Medical students
    • Patient safety standards
    • Training
  • Research, data and insight
    • Data and insight
    • Research
  • Miscellaneous
    • Health care
    • Social care
    • Jobs and voluntary positions
    • Suggested resources

News

  • News

Find results in...

Find results that contain...


Date Created

  • Start
    End

Last updated

  • Start
    End

Filter by number of...

Joined

  • Start

    End


Group


First name


Last name


Country


Join a private group (if appropriate)


About me


Organisation


Role

Found 341 results
  1. Content Article
    The Patient Safety Commissioner outlines the range of different stakeholders she has met within her first 100 days in office, including patients, healthcare staff, patient safety specialists and healthcare providers. She also details the number of different areas of concern that have been raised with her in this period, including: pelvic mesh complications isotretinoin side effects painful gynaecological investigations Covid vaccination concerns mental health difficulties fluoroquinolone side effects Yellow Card scheme reporting concerns about electroconvulsive therapy. The report then sets out in more detail her reflections on patient safety concerns relating to the three medical interventions covered by the Independent Medicines and Medical Devices Safety Review: pelvic mesh, Sodium valproate and Primodos. She also highlights some positive areas of patient safety work she has encountered in her first 100 days in office, including the Scan 4 Safety initiative, NHS Resolution’s work on consent resources and how the new Patient Safety Incident Response Framework (PSIRF) is seeking to ensure that patients’ voices are included in incident investigations. The report concludes by setting out her top three priorities: 1. Culture Change The Patient Safety Commissioner plans to: hold a public consultation on the Principles of Better Patient Safety for the Patient Safety Commissioner work with healthcare leaders to put patient voice at the core of their activity and reporting amplify patients’ voices in all parts of the health system to ensure they are heard identify and highlight where patient voice is neglected challenge organisations to identify a named patient voice on all Boards and to place patient stories at the top of their meeting agendas campaign to improve the use of Yellow Card reporting campaign to see the NHS number used as the default and unique identifier ·work to ensure patients are engaged in the development of all national specifications develop the Patient Safety Commissioner website as a hub of best practice in championing patient voice. 2. Pelvic mesh The Patient Safety Commissioner plans to: co-produce resources for patients and GPs about side effects from pelvic mesh surgery work with NHS England to provide patients choice of access to specialist mesh centres work with the health system to ensure that information is available to all patients on national registries. 3. Sodium valproate The Patient Safety Commissioner plans to: support the health system to include the views of all stakeholders including patients to reduce harm from sodium valproate to the lowest possible level work with health leaders to ensure that all relevant patients are on a Pregnancy Prevention Plan (PPP) and given the necessary information collaborate with partners to ensure annual reviews are carried out by specialist prescribers work with partners across health to eliminate dispensing of sodium valproate in unlabelled white boxes work with professional regulators to streamline the advice to their registrants on sodium valproate and contraception raise patient awareness through charity collaboration.
  2. Content Article
    Over the past few years, Patient Safety Learning has heard from many patients about significant safety concerns relating to hysteroscopy procedures in the NHS.[1] From the countless women who have shared individual experiences on the hub to the conversations we have had with the patient group the Campaign Against Painful Hysteroscopy, it is clear that this is a topic needing further exploration and advocacy from a patient safety perspective. I therefore welcomed a recent opportunity to engage with healthcare professionals involved in hysteroscopy procedures and share these concerns when I was invited to attend the Association of Anaesthetists Winter Scientific Meeting 2023 last month. This is the Association’s flagship conference, attended by healthcare professionals from across the UK, and I was invited to contribute to a panel session. This was focused on differing approaches to sedation for hysteroscopy procedures in both operating theatres and outpatient settings. Healthcare professional perspective from Leeds Hysteroscopy is a procedure used as a diagnostic tool to identify the cause of common problems such as abnormal bleeding, unexplained pain or unusually heavy periods in women. It involves a long, thin tube being passed through the vagina and cervix, into the womb, often with little or no anaesthesia. The panel session started with a presentation about hysteroscopies from Dr John Dalton, Dr Tracy Jackson and Maria Chalmers, Specialist Nurse Hysteroscopist. Maria spoke about the approach to hysteroscopy at the Leeds Centre for Women’s Health, emphasising the importance of: appropriate patient consent for the procedure discussing the likelihood of pain in advance of obtaining consent the patient’s right to withdraw consent or stop the procedure at any time. They described how patients, if they wanted to, were invited to review the procedure on a screen, and reported that there had been positive feedback from patients who have undergone procedures with this option. They also spoke about the value of these procedures taking place in outpatient settings where possible, creating a quicker diagnostic assessment. In their presentation, they reflected on the importance of collecting data about patient outcomes and pointed to broadly positive satisfaction scores with their service. Reflections on consent It was positive to hear a strong emphasis on the importance of patient consent, both before and during a procedure. It is an area of concern that has been consistently raised with us by patients who have undergone hysteroscopy. Through our work, we know that a significant number of women are not given sufficient information beforehand about the nature of the procedure or the potential for high levels of pain. Many have told us they were not asked about their medical history or offered different options for pain relief. These patients often reflect that the consent they gave was therefore not informed. When a patient experiences unexpected levels of pain, they can understandably feel very unsafe. This can lead to lasting trauma and a fear of accessing further important procedures or screenings. It’s therefore essential to make sure women undergoing this procedure feel they have been given all the information available. Panel discussion I introduced the concerns being expressed by many women and this generated an open discussion with colleagues from Leeds and an engaged audience of anaesthetists, many of whom were unaware of the issues that patients are raising about outpatient hysteroscopy. In the panel discussion I spoke about the experiences that have been shared with us at Patient Safety Learning. Some women have described how the lack of forewarning about this procedure, coupled with the trauma of the experience itself, left them feeling that both their body and their trust had been violated. Many women have also described receiving little or no pain relief and not being given the information they needed to make an informed choice about their own care and their own bodies. More than 50,000 people have viewed our community discussion on the hub about hysteroscopy experiences, with many having shared awful experiences exhibiting bullying, lack of compassion, lack of information and horrendous pain. Recent research, published in the British Journal of Anaesthesia, shows that a significant number (17.6%) of women rate their pain during hysteroscopy as greater than 7/10, and only 7.8% report no pain at all.[2] We know that outpatient hysteroscopy is a valuable procedure when done right, with full information, appropriate pain relief options and informed consent. However, as we have heard all too often from patients, in many cases this is not what they are experiencing.[3] Similar concerns were raised this week in a debate in the House of Commons. When discussing the implementation of good practice in these procedures, Government Minister Maria Caulfield note that such guidance was only as effective as its implementation: “The royal college is important because it can bring clinical change on the ground, but it is not enough just to assume that its updated guidance will be enough to change what happens in practice.”[4] Patients and campaigners are not unsupportive of hysteroscopy as a procedure. However, I shared our view, and that of many, that patients should not be expected to tolerate extreme pain or inconsistency of service. I emphasised a need for: increased efforts to ensure that good practice is shared widely and consistently applied. more research to better inform risk assessments about which women are most likely to affected by severe pain. ensuring that all those healthcare professionals involved in these procedures understand the importance of listening to and responding patients, giving women a range of pain relief options and providing the option to stop the procedure. It was useful to discuss with Maria and other clinical colleagues the value of hysteroscopy and the efforts that some centres are making to ensure that patients’ needs are met, and their voices heeded. It was helpful also to see in person the responses of anaesthetists in the room. There was, in some cases, clear concern about the negative experiences that have been shared with Patient Safety Learning by patients. Then we had some interesting reflections on the pain scores presented by the staff at Leeds. Many anaesthetists expressed shock that despite the good service being provided there, median pain scores are 5 out of 10. Some anaesthetists commented that patients wouldn’t be let out of recovery rooms by nursing staff with that extent of pain, and some said that they themselves wouldn’t want to undergo such a procedure in an outpatient setting with that median pain rating. The discussion was an important multi-disciplinary conversation of the value of hysteroscopy as a procedure while highlighting the very real concerns that women are experiencing when Royal College of Obstetricians and Gynaecologists guidelines are not being met consistently. The opportunity to engage in discussion with clinicians who are aiming to put patients’ experience at the heart of their service was much appreciated and we’re going to follow up with Maria and John to hear more about their service and the plans they have for continual improvement and for the best experience for women. We applaud the Association of Anaesthetists for highlighting these issues and aim to engage further to increase awareness of hysteroscopy pain and the need for urgent action. We look forward to sharing the recording of the session via the hub as soon as it becomes available. Join the conversation There is much work still needed to raise awareness of the patient safety issues concerning hysteroscopy procedures and to make the changes required to ensure good practice is applied consistently across the country. In the coming weeks, we will be publishing a new policy blog looking at this in greater detail and considering what more needs to be done to improve patient safety. In the meantime, if you have an experience you would like to share with us, please do get in touch. Perhaps you are a healthcare professional with insights to share on this topic? A patient who has had a hysteroscopy? A researcher? We'd love to hear from you if have a different perspective to add. You can join the conversation on the hub or get in touch with us directly by emailing content@pslhub.org. References 1. Campaign Against Painful Hysteroscopy, Open letter to the Department of Health and Social Care, 20 October 2020 2. Richard Harrison, William Kuteesa, Atul Kapila, Mark Little, Wiebke Gandhi, Deepak Ravindran, Carien M. van Reekum and Tim. V Salomons, Pain-free day surgery? Evaluating pain and pain assessment during hysteroscopy, 13 September 2020 3. Patient Safety Learning, Guidance for outpatient hysteroscopy: Consultation Response, 16 March 2022 4. House of Commons Debate, NHS hysteroscopy treatment, 31 January 2023
  3. Content Article
    What is a Westminster Hall debate? Westminster Hall debates give Members of Parliament (MPs) an opportunity to raise local or national issues and receive a response from a government minister. Any MP can take part in a Westminster Hall debate. Hysteroscopy procedures in the NHS In this debate Lyn Brown MP noted the significant number of women who experience extreme levels of pain when undergoing hysteroscopy, highlighted by groups such as the Campaign Against Painful Hysteroscopy. She shared several patient testimonies, raising concerns about healthcare professionals dismissing and ignoring patient feedback and emphasised the need for NHS trusts to offer patients who need a hysteroscopy a choice of appropriate pain relief. Key issues raised in this debate included: Concerns patients who have negative experiences in relation to hysteroscopy may be afraid to access important health procedures in future, with a long-term impact on their health. A lack of formal data collection by the NHS on cases of painful hysteroscopy. Concerns that a new proposed target of aiming for 90% of hysteroscopy happening within outpatient rooms, which has emerged from the Getting It Right First Time programme, may exacerbate the number of cases where patients do not receive appropriate pain relief options. That new good practice guidance from the Royal College of Obstetricians and Gynaecologists (RCOG) on this issue is due to be published imminently. That more research is needed into hysteroscopies, particularly for post-menopausal women. Concerns about the need to challenge potentially embedded views among gynaecologists in regards to pain and patient experiences of this procedure. Feryal Clark MP recounted her personal experience of having a painful hysteroscopy procedure. This debate was responded to on behalf of the Government by Maria Caulfield MP, Minister for Mental Health and Women’s Health Strategy. Key points in her response included: She was planning to meet with the Campaign Against Painful Hysteroscopy group to discuss these issues further. The importance of the new RCOG best practice guidelines being rolled out in practice, and ensuring this brings clinical change on the ground. That hysteroscopy had not been included in the initial priorities of the Women’s Health Strategy as the Government wanted to wait on the new RCOG guidance before acting. There is a space being set up on the NHS website for women’s health so that women who are going for a procedure can easily access all relevant information. She has asked Professor Dame Lesley Regan, the Government’s Women’s Health Ambassador, to discuss the issues surrounding hysteroscopies further with Dr Henrietta Hughes, the Patient Safety Commissioner for England. Watch the debate in full Read the transcript Join the conversation Are you a healthcare worker with insights to share on this topic? Are you a patient who has had a hysteroscopy? Perhaps you are a researcher or have a different perspective to add? You can join the conversation here or get in touch with us directly by emailing content@pslhub.org. Related reading Patient Safety Learning, Improving hysteroscopy safety, 6 November 2020. Patient Safety Learning, Through the hysteroscope: Reflections of a gynaecologist, 26 January 2021. Patient Safety Learning, Guidance for outpatient hysteroscopy: Consultation Response, 16 March 2022. Richard Harrison, “Pain-free hysteroscopy”, a blog by Dr Richard Harrison, 6 November 2020.
  4. Content Article
    Recommendations Physicians at all stages in their careers need to be conscious of the demands placed on them professionally and personally and should balance those demands with rest to avoid excessive fatigue or overcommitment. The medical directors of outpatient units and chairs of hospital departments of obstetrics and gynaecology may consider developing call schedules and associated policies that balance the need for continuity of care and the health care providers’ need for rest. With the growing concern about the potential consequences of health care provider fatigue on patient safety, physicians should commit to evaluating the effects that fatigue has on their professional and personal lives and should demonstrate willingness to adjust workloads, work hours, and time commitments to avoid fatigue when caring for patients.
  5. Content Article
    Sarah's tips for women when speaking to medical professionals Know your body and come prepared Equip yourself with evidence and knowledge Rule out the worst-case scenarios Bring back-up Treat it like a collaboration Try to understand the challenges your doctor faces
  6. News Article
    The Conservatives have been accused of “failing women” as analysis reveals gynaecology waiting times have trebled in the past decade, with more than 540,000 waiting for NHS care. NHS England data shows that in October 2012, the average waiting time to see a gynaecologist was 4.8 weeks. By October 2022, the most recent month for which figures are available, that figure had increased by 225% to 15.6 weeks. Many of the conditions experienced by women waiting to see a gynaecologist are progressive. Left untreated, they can need more complex or invasive surgery. Thousands are living in extreme pain as a result of the long waits, doctors, health experts and charities told the Guardian. The figures reveal that 38,231 women have been waiting more than a year. Ten years ago there were 15 women in England waiting longer than 12 months – and no one waiting two years. Today, 69 women have been waiting more than 24 months. Dr Ranee Thakar, the president of the Royal College of Obstetricians and Gynaecologists, said: “This new analysis adds to our own research that gynaecology waiting lists were outstripping other specialities long before the pandemic, and they continue to grow rapidly. “Shockingly, the fact we can now track this pattern back 10 years, shows how long overdue action is to address the unequal growth in waiting lists.” Thakar added: “Women’s health has been consistently deprioritised. Gynaecology waiting times are currently the longest we’ve seen since waiting list targets were introduced, leaving thousands of women with symptoms including extreme pain, heavy menstrual bleeding and incontinence.” Read full story Source: The Guardian, 19 December 2022
  7. Content Article
    What is an Adjournment Debate? There is a 30 minute Adjournment Debate at the end of each day's sitting of the House of Commons. They provide an opportunity for an individual backbench MP to raise an issue and receive a response from the relevant Minister. Unlike many other debates, these take place without a question which the House of Commons must then make a decision on. Foetal valproate spectrum disorder: Fatalities Caroline Nokes, MP for Romsey and Southampton North, opened this debate by talking about the case of Jake Alcroft, a 21-year-old who died in April this year after an infection triggered by problems with his kidneys. The coroner listed foetal valproate syndrome as a contributing factor to his death because of the physical damage done to Jake as an exposed baby, which meant that his bowel and bladder did not work properly and he relied on urostomy and colostomy bags. Some key points highlighted in this debate included: Warnings about sodium valproate and the risks during pregnancy are still not being consistently displayed on pharmacy prescriptions. Some of the recommendations made in relation to this by the Independent Medicines and Medical Devices Safety (IMMDS) Review have still not been implemented effectively. There are concerns that the illness can continue down the generations, and that is not yet well understood but it is causing real fear for the families who have been affected so far. Towards the end of this debate, Caroline Nokes made three requests for the Minister: To acknowledge that sodium valproate has contributed to a death. Asking if she was satisfied that the pregnancy prevention programme is adequately effective and that the information is properly communicated to women of child-bearing age. Calling for redress for patients and families affected by this, as recommended by the IMMDS Review. Maria Caulfield MP, Minister for Mental Health and the Women's Health Strategy, provided the Government response at the end of this debate.
  8. News Article
    More than 1000 investigations have been launched in Scotland over the past decade into adverse events affecting women and infants' healthcare. Figures obtained by the Herald show that at least 1,032 Significant Adverse Event Reviews (Saers) have been initiated by health boards since 2012 following "near misses" or instances of unexpected harm or death in relation to obstetrics, maternity, gynaecology or neonatal services. The true figure will be higher as two health boards - Grampian and Orkney - have yet to respond to the freedom of information request, and a number of health boards reported the totals per year as "less than five" to protect patient confidentiality. Saers are internal health board investigations which are carried out following events that could have, or did, result in major harm or death for a patient. Major harm is generally classified as long-term disability or where medical intervention was required to save the patient's life. They are intended as learning exercises to establish what went wrong and whether it could have been avoided. Not all Saers find fault with the patient's care, but the objective is to improve safety. NHS Lanarkshire was only able to provide data from April 2015 onwards, but this revealed a total of 194 Saers - of which 102 related to neonatal or maternity services, and 80 for obstetrics. A Fatal Accident Inquiry involving NHS Lanarkshire has already been ordered into the deaths of three infants - Leo Lamont and Ellie McCormick in 2019, and Mirabelle Bosch in 2021 - because they had died in "circumstances giving rise to serious public concern". Read full story (paywalled) Source: The Herald, 10 December 2022
  9. News Article
    The deputy chair of NHS England has said it should be as ‘demanding’ of medical cover in obstetrics and neonatal care as it is for emergency departments, to improve safety in the wake of repeated care scandals. Sir Andrew Morris, who was the long-serving chief executive officer of the well-regarded Frimley Health Foundation Trust, said the service would “expect a consultant to be on duty in an emergency department [from] 8am till 10pm, or midnight, seven days a week”. Speaking at NHS England’s public board meeting yesterday, Sir Andrew said: “We haven’t set that similar expectation out for [maternity care]. I know we’re saying we’re expecting that two ward rounds are undertaken, each day, seven days a week, but that is very different to the service I think is appropriate for this type of semi-emergency operation, that most trusts run. “I’d like us to be as demanding of organisations [in relation to obstetrics and neonatal] as we are for the emergency department.” Read full story (paywalled) Source: HSJ, 1 December 2022
  10. Content Article
    View an up-to-date spreadsheet of responses to the campaign’s ‘Dissatisfaction Survey’ so far. These are women’s lived experiences of horrendous outpatient hysteroscopy procedures have been shared with the Campaign Against Painful Hysteroscopy Survey.
  11. Content Article
    Bell Ribeiro-Addy, Member of Parliament (MP) for Streatham, who secured this debate, highlighted some of the key statistics around black maternal health and mortality in the UK: Black babies have a 121% increased risk of stillbirth and a 50% increased risk of neonatal death. Asian babies have a 55% increased risk of stillbirth and a 66% increased risk of neonatal mortality. Black women have a 43% higher risk of miscarriage, and black ethnicity is now regarded as a risk factor for miscarriage. She also referred to the findings of black maternal experiences survey carried out by grassroots organisation Five X More published earlier this year. She noted that this report highlights all the negative interactions that women experienced with healthcare professionals, from feeling discriminated against in their care to receiving a poor standard of care, which put their safety at risk, and being denied pain relief because of the trope that black women are less likely to feel pain. The Government response in this debate was provided by Maria Caulfield MP, Minister for Mental Health and Women’s Health Strategy.
  12. News Article
    More than a third of the 3143 counties in the US are maternity “deserts” without a hospital or birth centre that offers obstetric care and without any obstetric providers—and the situation is getting worse, says a report from the March of Dimes organisation. Maternity deserts have increased by 2% since the 2020 report, said the organisation which seeks to improve the health of women and babies. Care is diminishing where it is needed most—especially in rural areas. It affects nearly seven million women of childbearing age and about half a million babies. Read full story (paywalled) Source: BMJ, 17 October 2022
  13. Content Article
    Dear Matt Hancock and Nadine Dorries, We ask the DHSC to make provision for all NHS Trusts to work with the RCoA and RCOG to establish safely monitored IV ‘conscious’ sedation with analgesia as a treatment option for hysteroscopy+/-biopsy. Currently, Trusts put almost all patients through Trial by Outpatient Hysteroscopy and only those patients who fail (usually due to acute pain) are allowed a GA. There is no routine option of IV sedation with analgesia or spinal anaesthesia. We ask too that NHS Trusts give all hysteroscopy patients upfront a fully informed ‘Montgomery’/ GMC CHOICE of: o no anaesthetic o LA / regional / epidural o IV sedation with analgesia o GA The choice should be made after thorough discussion with the patient about her medical history, risk factors and preferences. WHAT IS HYSTEROSCOPY? Hysteroscopy is endoscopy of the womb. Like colonoscopy, it’s used to detect cancer, pre-cancer and benign abnormalities. Hysteroscopy done in outpatients with miniature surgical tools enables the removal of polyps and small fibroids without an incision or general anaesthetic [GA]. Here the similarity with colonoscopy ends. For NHS colonoscopy, the patient is routinely offered a CHOICE of Entonox or IV sedation with analgesia. Some patients request and receive GA. The risk of perforation (and potential death) is less when performed on a patient under IV ‘conscious’ sedation than under GA. The NHS therefore wisely prefers colonoscopy under ‘conscious’ sedation to GA. NHS colonoscopy services aim to protect patients from severe pain. Apart from assuring basic human respect and dignity, the NHS recognises that people traumatised by a severely painful colonoscopy may delay or not return for vital cancer diagnosis or treatment. UPDATE FROM THE CAMPAIGN AGAINST PAINFUL HYSTEROSCOPY [CAPH] Severely painful outpatient hysteroscopy is the next medical scandal after vaginal mesh. Cheap, quick and easy-to-use NHS vaginal mesh kits helped the majority of patients, and saved precious time and resources. Cheap, quick and easy-ish NHS outpatient hysteroscopy [OPH] without anaesthesia/sedation causes severe pain/distress/trauma to approx. 25% patients and saves precious time and resources. Like the vaginal mesh campaigners, hysteroscopy patients who’d been seriously harmed by a flawed medical policy started asking questions. Hysteroscopists assured us that our excruciating and unforgettable pain was very ‘unusual’ and affected only 2% to 5% of patients. This statistic didn’t fit with patients’ observation of OPH clinics. So these ‘unusual’ women started googling, then exchanging stories via social media. Soon they formed into Facebook and Twitter groups. Involved politicians. Interrogated health authorities. Looked for medical explanations. Approached professional colleges and societies. Sought out empathetic and intelligent doctors. Studied the law of informed medical choice and consent. By 2014 a campaign was born, greatly assisted by Lyn Brown, MP (Lab, West Ham) who was prepared to stick her neck out for her constituents and for other women who’d been traumatised and dismissed as ‘incorrect’ in their perception of hysteroscopy pain. These women were clearly of the ‘wrong demographic’! Too anxious, had too narrow cervical canals, too tilted wombs, were too emotionally labile, too black, too white, too rich, too poor, too educated, too urban... By early 2020 the Campaign Against Hysteroscopy had amassed a google survey of 1,000+ hideous, predominantly NHS, stories. We sought stories of specifically painful hysteroscopy since our aim was to identify any common features in patients’ medical histories or the operating teams’ conduct of a painful procedure. We hoped that our findings would aid future patient selection and choice. We gave our results to the Presidents of RCOG and the British Society for Gynaecological Endoscopy. The survey’s free text was shocking: It was barbaric and one of the most painful experiences of my life including vaginal childbirth. I begged them to stop but they wouldn’t. It was like torture It was a terrible experience that I don’t think I will ever forget Just before lockdown, the Health Service Journal published an analysis of our survey [Matt Discombe, HSJ, 2 March 2020] “Around 520 women who attended NHS hospitals in England to undergo hysteroscopies — a procedure which uses narrow telescopes to examine the womb to diagnose the cause of heavy or abnormal bleeding — have told a survey their doctors carried on with their procedures even when they were in severe pain.” We continued our on-going survey, asking about pre/post-menopausal status; vaginal/caesarean delivery/nulliparity; endometriosis/dysmenorrhea/previous traumatic gynae; mental health; hospital information about pain risk; choice of LA/GA/IV sedation; pain-scores at different OPH stages; whether the hysteroscopist stopped if the patient was in pain/distressed; preferred mode of future hysteroscopy, etc. At the end of the survey we asked, “Is there anything else you’d like to tell us?” I was given a brown paper bag to breath into as I hyperventilate with the pain. The male consultant made fun of me. Anaesthetic should be compulsory, I have a high pain threshold but was most painful thing I have ever felt, still feeling traumatised after the event. Staff were appalling. 5 nurses and doctor laughed when they could see I was in terrible pain, shocking The pain after the procedure was finished, was excruciating, body started to go into shock. Ended up in A&E pumped full of morphine and admitted overnight for observation. Never again unless under GA. Ask them if they are in pain rather than asking them about their last holiday whilst their uterus is dilated. I am a midwife myself and spoke to the consultant explaining how anxious I felt regarding the procedure, as I had had a very painful / difficult removal of mirena coil previously and been told I had a cervical stenosis: I asked could I have sedation and was declined saying it would only be “ brief discomfort” and to just take painkillers a couple of hours before At one point that evening I was so confused and in pain, feeling sick and with a high resting heart rate that I nearly called an ambulance. I was alone. Nobody suggested I should have someone at home with me. Felt embarrassed because of yelling (due to the incredibly sharp pain) The doctor and nurse were fine but I was screaming in pain and doctor counted down from 10 to 1 to try to get me to hold on until she could finish it Gas and air made me feel light headed but made absolutely no difference to the pain I experienced. The Cumberlege Review ‘First Do No Harm’ of July 2020 categorised breaches of patient safety into themes. [https://www.immdsreview.org.uk/Report.html] Three of these themes sum up the current harms caused by an over-zealous, blanket NHS policy of reduced-cost OPH: Cumberlege Theme 1, "No-one is listening" – Hysteroscopists lack empathy; they ignore patients’ requests for GA and fail to stop when the patient is in distress. Cumberlege Theme 3, "I was never told" - Hysteroscopists fail to warn patients of the risk of severe pain and don’t tell patients upfront that they have the option of GA. Cumberlege Theme 10, "Collecting what matters" - Hysteroscopists are wilfully blind to Patient Reported Outcomes – they belittle and don’t record the patients’ own short-term, medium-term and long-term outcomes when these cause severe pain and PTSD. CAPH has frequently heard of hysteroscopists telling GPs that a crying patient “tolerated the procedure well”. WHAT IS THE DATA ON HYSTEROSCOPY PAIN? Just as with vaginal mesh, very few gynaecologists have systematically collected pain scores from all their OPH patients. When OPH pain-scores are reported in English journals usually only the median or mean scores are given. Hundreds of members of our Action/Support group were never asked for a pain-score. NHS OPH pain audits obtained by CAPH under the Freedom of Information Act shows that currently 1 in 4 NHS England hysteroscopy outpatients typically suffers severe pain of 7/10 or more. [ www.whatdotheyknow.com - see ‘Outpatient hysteroscopy/biopsy’] The British Society for Gynaecological Endoscopy’s 2019 bespoke 81-hospital survey of 5,000+ hysteroscopy patients from BSGE members’ own NHS clinics reports a mean pain-score of 5.2/10. So clearly it’s not the “mild discomfort” that most patient leaflets claim. Nor is it now feasible to say that severe pain is experienced by only 2-5% of patients. [ www.bsge.org.uk BSGE Ambulatory Care Network Meeting Feb 2020] CAPH has asked for the full range of BSGE members’ OPH pain-scores under FOIA. The British Journal of Anaesthesia this year published a review evaluating patients’ reported pain compared with hysteroscopists’ assessment of OPH pain over 8 years at Royal Berkshire Trust – a good clinic which is barely mentioned in our survey. [Harrison, Salomons 2020]. 17.6% of patients reported severe pain of 7/10 or more, while 7.8% reported no pain. The authors concluded that since patients were likely to experience pain then they should be warned of this. WHAT DOES THE NHS TELL PATIENTS ABOUT HYSTEROSCOPY PAIN? NHS hysteroscopy services appear to follow ex-Cancer Tsar Prof Sean Duffy’s opinion “Overall we think that too much emphasis is put on the issue of pain surrounding outpatient hysteroscopy.” [BMJ. 2001 Jan 6; 322(7277): 47] Patient leaflets almost invariably tell women to expect “mild discomfort”, on a par with moderate period pain. So, without any pre-op assessment the NHS pushes almost all women through Trial by Outpatient Hysteroscopy and reserves GA for those who ‘fail’. The womb endoscopy patient is NOT routinely offered the option of GA. If she asks for one, the request is usually declined – even before the covid-19 pandemic. Thus the vast majority of NHS clinics wilfully ignore the RCOG/BSGE 2018 statement instructing gynaecologists to offer all hysteroscopy patients the choice of GA up-front, and to stop an OPH if the patient is distressed. [https://www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg59/] Yes, there are some excellent, highly skilled and compassionate OPH clinics but, sadly, most put cost-effectiveness before compassion or ‘Montgomery’ informed patient choice, thus denying patients genuine informed consent. Most hospital leaflets tell patients to take over-the-counter meds from home. There is no pre-med in clinic. The woman gets a ‘vocal local’ – hairdresser chit-chat- pioneered in rural Kenya by Marie Stopes. The woman is sometimes held down if distressed and agitated. She may receive potentially painful injections into the cervix as ‘rescue analgesia’. Unfortunately the cervical LA doesn’t anaesthetise the top of the womb, from which the cancer-detecting biopsy is taken. [www.bsge.org.uk Ambulatory Care Network 2020 Keynote Speaker on ‘patchy and unpredictable’ cervical LA] WHAT DOES THE CAMPAIGN AGAINST PAINFUL HYSTEROSCOPY WANT? 1. Every single NHS hospital to use – at the very least – the RCOG patient leaflet (CAPH helped write) which mentions the risk of SEVERE pain outlines clinical risk-factors for severe pain offers patients upfront the option of a GA/IV sedation with analgesia 2. The DHSC and RCOG to work with the Royal College of Anaesthetists to train hysteroscopy teams and establish safe IV conscious sedation with analgesia as a CHOICE available to all womb endoscopy patients. 3. The DHSC to permanently remove any Best Practice Tariff or financial incentive which removes timely access to GA, IV sedation with analgesia or other anaesthetist supported service. 4. A pre-op assessment for all hysteroscopy patients, meaning an end to ‘See & Treat’ clinics, which often coerce women into polyp and fibroid removal without patients having time to consider whether they’d prefer GA/ IV sedation/ regional anaesthesia rather than a local which doesn’t anaesthetise the top of the womb. The current ‘One-Stop’ clinic endangers women who attend the clinic alone and then have to drive or travel home on their own, often in severe pain, bleeding and traumatised. This is unacceptable and must stop. 5. Standardised, regulated, updated high quality training and accreditation for all hysteroscopists together with up to date equipment. Hysteroscopists should be taught to recognise cohorts at high risk of severe pain, develop listening skills and treat women with respect. 6. Full transparency about the financial sponsorship of NHS hysteroscopists’ training by the medical devices industry and the resulting bias towards particular manufacturers’ preferences and cost-effectiveness rather than patient experience. 7. Severe procedural pain to be classed and recorded as a Serious Adverse Event. Yours faithfully, Elaine Falkner (Chair), Pamela Howe (Secretary), Jocelyn Lewis, Lorraine Shilcock, Denise Shafeie, Gill Johnson, Katharine Tylko (on behalf of) The Campaign Against Painful Hysteroscopy www.hysteroscopyaction.org.uk Twitter: @hysteroscopyA Facebook: Campaign Against Painful Hysteroscopy
  14. News Article
    New study results in more precise language in the federally mandated warning about this possibility. (Article from the USA) Women who choose to use an intrauterine device, or IUD, for birth control should be aware of the very small possibility that the device could puncture their uterus. They should know how to recognize that circumstance if it occurs, according to a new study published in The Lancet. The U.S. Food and Drug Administration mandated the study to evaluate women's risks when an IUD is placed in the year after giving birth and when an IUD is placed during the period that a woman is breastfeeding a baby. These results were compared, respectively, with non-postpartum insertions and insertions in non-breastfeeding individuals, explained UW Medicine’s Dr. Susan Reed, the study’s lead author. Across the study cohort of 327,000 women, the percentage of perforation cases diagnosed within five years of IUD insertion was 0.6 %, the study concluded. The risk of perforation increased by nearly seven times if it was inserted between four days and six weeks postpartum, and increased by about one-third if inserted during the span of breastfeeding. The risk of an IUD-related perforation was relatively lower when inserted in women who were more than a year beyond delivery, in women who had never had a baby, and when the insertion occurred at delivery. Read full article here
  15. News Article
    A sexual assault survivor chooses sterilization so that if she is ever attacked again, she won’t be forced to give birth to a rapist’s baby. An obstetrician delays inducing a miscarriage until a woman with severe pregnancy complications seems “sick enough.” A lupus patient must stop taking medication that controls her illness because it can also cause miscarriages. Abortion restrictions in a number of states and the Supreme Court’s decision to overturn Roe v. Wade are having profound repercussions in reproductive medicine as well as in other areas of medical care. “For physicians and patients alike, this is a frightening and fraught time, with new, unprecedented concerns about data privacy, access to contraception, and even when to begin lifesaving care,” said Dr. Jack Resneck, president of the American Medical Association. Even in medical emergencies, doctors are sometimes declining immediate treatment. In the past week, an Ohio abortion clinic received calls from two women with ectopic pregnancies — when an embryo grows outside the uterus and can’t be saved — who said their doctors wouldn’t treat them. Ectopic pregnancies often become life-threatening emergencies and abortion clinics aren’t set up to treat them. It’s just one example of “the horrible downstream effects of criminalizing abortion care,″ said Dr. Catherine Romanos, who works at the Dayton clinic. Read full story Source: AP News, 16 July 2022
  16. News Article
    Emma Hardy MP has secured a Westminster debate on gynaecological wait times. Gynaecology waiting lists across the UK have now reached a combined figure of more than 610,000 – a 69% increase on pre-pandemic levels. New analysis by the Royal College of Obstetricians and Gynaecologists (RCOG) shows that in England, gynaecology waiting lists have grown the most by percentage increase of all elective specialties. Emma is co-chair of the All Party Parliamentary Groups (APPGs) for Surgical Mesh and Endometriosis - both come under the heading of ‘gynaecological conditions’ and both are being impacted by increased waiting times. Through her involvement with these APPGs, Emma has heard the testimony of so many women whose lives have been impacted by conditions that can be so painful and debilitating that they impact on every aspect of family, social and work life. Emma will ask the minister to launch an investigation into possible gender bias in the prioritisation of gynaecology services and ensure that elective recovery will address the unequal growth of gynaecology waiting lists compared to other specialties. Emma said: "It is completely unacceptable that 610,000 women are waiting for gynaecological care across the UK. The reality is that many of these women will be in excruciating pain awaiting treatment, unable to go about their day-to-day lives." Read full story Source: Hull Daily Mail, 5 July 2022
  17. Content Article
    My health has always been a ‘challenge’ as they say. I had a stoma in 1988, when I was 28 years old, for bowel disease. They were never sure if it was Crohn's disease or ulcerative colitis, but I was more than happy to kiss my rotten colon goodbye. It restored my bowel health and I carried on working and living my life with my husband and child. Two years after the ileostomy, I had further abdominal problems and a MRI suggested ovarian cancer. I had an emergency laparotomy which revealed severe endometriosis which had obliterated my whole pelvis and infiltrated my internal organs. The gynaecologist closed me up and said nothing could be done as my pelvis was ‘frozen’ and I would have to be treated medically. The condition plagued me for the next 20 years; I developed cysts in the pelvis which were drained repeatedly. My health was at times poor but I still managed to work and live my life. In 2010, my gynaecologist retired and I was referred to a new team. They were based 80 miles from where I lived, which was a nuisance but I felt it was worth the journey to have the best. They were adamant I needed a hysterectomy – they were not happy with the recent imaging and felt one of the cysts looked suspect. I spent years putting this off as I was very fearful. I had been told it could be very easy to make things much worse. In 2012 my mum had a massive brain haemorrhage and I became her carer, but by 2014 they were still saying I needed the surgery to find out what the suspect mass actually was so, reluctantly, I agreed. January 2015 The hysterectomy went ahead at a private hospital. I was in BUPA, my mother was brain damaged and I was her carer, I needed this op out of the way so I could go back to caring for her. I awoke from the surgery to be told it had been very difficult – I felt totally wiped out. Two days after the operation, there was no improvement. I was encouraged to get up from the bed; I could barely move but I managed a few steps when I felt something running down my legs forming a green puddle on the floor. My bowel had perforated and the contents were flooding out of my vagina. My consultant was away and I was transferred late at night to the local NHS hospital. That was a nightmare in itself as they at first wouldn’t accept me. I lay there in A&E with warm liquid pumping out of me with every spasm of my bowel. I was convinced it was blood and I tried not to think of my loved ones whom I thought I’d never see again. My poor husband looked on helplessly; he spent a freezing night in the car as he wanted to be near me. I spent 3 months in hospital being fed through my central vein. I was told I may never eat or drink again and my whole life just fell apart. It was explained the suspect mass was in fact a twisted mess of bowel, adhesions and goodness knows what possibly caused by the repeated aspirations I’d had for the endometriosis. I was told because of the perforation I now had a fistula which is essentially a connection between my small bowel and my skin. Despite my numerous surgical experiences, I had never heard of such a thing but Dr Google soon educated me and it did not make good reading. I became seriously depressed, wanting my life to end. I was discharged in the spring of 2015 to a totally different world. I could by now eat small amounts but the holes appearing on my abdominal wall were evidence the fistula had not healed. I was too afraid to move as any activity meant I’d have ominous discharges from various orifices. I totally lost confidence in myself, the doctors and the world in general… I became a recluse. Life with a fistula was difficult. Apart from the constant dressings required to contain the output, I was in permanent pain and suffered frequent infections. Considering I had gone into hospital reasonably well and come out like this was almost too much to bear. I tried to access mental health support but I was put on a waiting list whilst my mental state got progressively worse. I was told I would have to wait for two years for the fistula to be repaired. It was a long wait, my daughter had a baby so that kept me going and I looked forward to being free of this demon within. I missed the old capable me so much. March 2017 The repair op took place this time in the NHS hospital, albeit as a private patient again. I couldn’t wait any longer and so once again made use of my medical insurance. Again I had serious complications. The days that followed the surgery were horrific, I truly wanted to die. My gut had stopped working, a condition called ileus. Bile was building up in the stomach so I had a nasogastric tube inserted; the thirst was causing me to have hallucinations. I tried to impress upon everyone how ill I was feeling, but I didn’t feel believed; they told me I was anxious and all my problems were normal post op things. My husband called as usual to visit, getting more worried as each day was passing. I had spiked a temperature of 39.6⁰C. I cried into his chest as I tried to sit up to relieve the horrific symptoms I was experiencing. Next minute I had no breath, I was suffocating. My husband called for help and, even at that point, I was told I was having a panic attack until the nurse saw my oxygen levels – they were 71% which was dangerously low. I was having a stage 1 respiratory arrest, and I was rushed to ICU and spent days fighting for my life. A three month hospital stay followed and this further catastrophe had resulted in a fistula worse than the one I went in with. I now had to wear three stoma bags, two of which leaked constantly. I felt a mutilated mess. Again, I left hospital a broken shell, with no support apart from my family who were also finding it hard to accept what had happened to me. Life now... It’s now 3 years since the failed repair and I have never recovered. It actually made things much worse. As well as the fistulae and three stoma bags, I now have bladder problems as part of my bladder was excised during the last op and gallbladder disease thanks to the parenteral nutrition. The inflammation in my body has led to autoimmune diseases, such as scleritis, which is an agonising and destructive eye condition. The whole awful experience has left me a broken, psychological wreck. I finally accessed mental health support at the end of 2019 and have been diagnosed with post traumatic stress disorder (PTSD), anxiety and depression. Life is difficult. In my mind there are so many unresolved issues which have plunged me into a deep pit of depression I can’t get out of. The therapy I now receive is ‘systemic’ so basically addresses how my husband and I are responding to the trauma, rather than the trauma itself. The initial trauma of my surgery going so wrong has now been followed by a second trauma of lack of support, feelings of worthlessness and the consequences of having a complex condition whilst living in rural west Wales where my local hospital can’t treat me. How I wish I’d said NO to that fateful hysterectomy! But we don’t do we. The surgeons are the experts, they lead and we follow, that’s how it works. Lamb to the slaughter springs to mind. That is probably unfair, my surgical luck was bound to run out one day, but I am angry at losing one of life’s most important gifts – good health. To make matters worse I’ve discovered that the suspect mass that they told me had to come out, had actually been identified 30 years previously. It was a harmless benign fibroma. That makes things harder to bear as I realise I probably never even needed the surgery. I didn’t complain or even ask many questions as I was too ill, traumatised and exhausted. My mother ended up in a home, my marriage is understandably struggling, my husband and I no longer work. I had nothing left to challenge anyone. My psychologist says I need answers to help me move on but I’m now told it’s too late. I have to go back to that hospital because I am now so complex my local hospitals won’t treat me. It’s a 3 hour round trip to a place that absolutely terrifies me. An enterocutaneous fistula is a very rare complication of surgery. But as I told my Consultant, it’s only rare until it happens to you. Then statistics become irrelevant. They seem to overlook the fact that there is a person behind that tiny statistic, who has to somehow learn to live again with all the fallout of that disastrous surgical experience.
  18. Content Article
    Puberty, birth control and cramps I grew up in Trinidad, in the Caribbean in a very Christian household, and attended religious primary and secondary schools. Sexual and reproductive health was discussed in a functional way in biology class. While we were taught about birth control methods (condoms, IUDs, etc), we were expected to follow the abstinence only path. The shame and stigma around premarital sex meant that a lot of incorrect information was passed from girl to girl. I was one of the lucky ones – my parents provided books, encyclopaedias and, no idea why or how we had them, medical encyclopaedias. From these books I learned about puberty and sexual differentiation With all this book knowledge I felt that I was well prepared for anything puberty threw my way. My first period was met with delight that I was finally a ‘woman’. My second was met with agonising cramps and being told, “stop being a baby, that’s life”. I learned the tricks – sleep on your side to prevent leaking (tampons were not allowed), get a hot water bottle, Buscopan tablets, always having a spare pad, count the days meticulously to avoid being embarrassed. We were taught that cramps were just a way of life and you had to just get on with it. In an all-girl school, period cramps were not considered a good excuse for PE or any physical activity. My period suddenly stopped In my second year of university (my first degree) I took on a very stressful course load and quickly became overwhelmed by the volume of work needing to be submitted every week. The stresses of university life made itself known by my period stopping. By the third month, I realised that something was definitely wrong, and I approached my mother with my concern. As soon as I’d articulated my concern my mother paled and gasped “ARE YOU PREGNANT?!” I was at a loss for words because, while I was in a relationship, it had not progressed to that point and I hadn’t even considered that my mother would think that. I immediately replied “Of course not.” This led to my first gynaecological visit, where my mother’s gynaecologist tried to insist I was pregnant and refused to accept that I wasn’t sexually active at 20. After a negative pregnancy test and a normal examination, they concluded that it was university stress, prescribed me a progesterone pill to restart my period and medication to regulate it. No further investigations were done, and without the knowledge to advocate for myself, I trusted in my doctor that he was right. My boyfriend at the time saw the medication as a gift – I could now safely have sex if I wanted to. I saw it as liberating for different reasons. I could skip a period, I knew exactly when my period would be so I could plan social activities and not be caught out, my periods were now pain-free and very light. I wished I had discovered this pill years before! As a doctor, I thought I knew what to expect with an IUD Six years later, with that relationship ended and me in another country pursuing my medical degree, I was still taking this pill to avoid periods even though I was single. However, with a varying schedule I kept missing my timing for the pill and, during my Obstetrics and Gynaecology rotation, on learning more about the copper Intrauterine device (IUD) I felt that this was a fool-proof method. Having attended clinics, been taught about the insertion of the IUD and having inserted some for patients myself, I felt confident that this was the method for me. How to insert an IUD: A properly sized speculum is inserted and adjusted to bring the cervix into view. A uterine sound is used for measuring to ensure high fundal placement of the copper IUD. The IUD is then placed. If, like me, your uterus is retroflexed, a tenaculum (device with 2 prongs) is used to grasp the cervix and straighten the uterus to avoid perforation. The above information was rattled off many times by doctors and nurses we observed as medical students, and we rattled it off to patients when we were allowed to assist. The other side of the curtain I went into that room thinking I knew everything. I had all the knowledge and experience from books and my teachers. This was going to be quick and easy. I was going to get this done, and re-join my peers for the rest of the day in clinic. The patient experience is definitely weird when you know that tomorrow you are going to come in and be face to face with the nurse who is currently all up in your insides. You try to make conversation and feel less awkward about the discomfort involved in a speculum insertion, you try to follow the instructions to “relax and take deep breaths.” But nothing prepared me for the white-hot searing pain that came after the words, “now you’re going to feel a little pinch.” I screamed. And immediately felt ashamed for it. Because, this is normal, right? This is what many woman go through. Why couldn’t I just grit my teeth and bare it? Why did I have to be so weak? Through clenched teeth I endured the rest of the insertion, got off the table and dressed and stumbled out to the waiting room before collapsing on a chair. My head was spinning, my insides writhed in agony and I couldn’t form words. I was sitting there in my white coat and scrubs and being stared at by all these women in the clinic. My clothes screamed that I was on the other side of this divide, and the curious stares drove me to leave. I stood up and walked out of the clinic and went to the café next door. I quickly realised what a mistake I’d made as I fainted and was luckily caught by a café patron and placed on a chair. A kind lady brought me a drink and sat with me while I waited for the ringing in my head to stop and my vision to return to normal. When I could stand without assistance, I got a taxi home where I got into bed and cried myself to sleep. Normalisation of female pain In the weeks and years that followed that experience, and now as a practicing doctor, I find myself asking, “why do we allow female pain?” Too often female pain is dismissed as ‘normal’ and from an early age we tell girls to accept menstrual cramps. It takes years for an endometriosis diagnosis to be made, all while the girl/woman is going through pain that can be so debilitating that they cannot go to school or work. In medical school and in practice, a lot of stress is placed on testicular pain and definitive treatment as soon as possible to save a testis. Meanwhile, possible ovarian pain/torsion is made to wait. Normalisation and diminishing female pain starts from a young age, and leads to the internalisation and acceptance of this by women. Painful periods, intercourse or just pelvic pain are often dismissed or trivialised as ‘a low pain threshold’, ‘making it up’, ‘excuses’, ‘all in your head’. Women learn to apologise for their pain. I have lost count of the number of women I have seen in the A&E who start off with “I’m sorry to bother you doc, but…”. We need to understand the female anatomy better Medical textbooks abound with descriptions of male anatomy. Journals are filled with erectile dysfunction treatment. For women, the same isn’t true. Prominent obstetric and gynaecological textbooks ignore detailed female anatomy. Illustrations such as this image of the female clitoral anatomy aren’t common in medical textbooks. If, as medical professionals, we don’t know the nerve supply to an area, how can we truly say, “this won’t hurt?” In order to truly understand female pain, we need a better understanding of female anatomy and to stop thinking that if they’re not complaining, it doesn’t hurt. Improving patient knowledge also goes a long way in being able to properly communicate their pain. When a large proportion of women use the word vagina to mean the vulva, it’s difficult to effectively communicate where the pain is. Validating the patient’s experience I don’t have an easy solution, but here’s how I’m combatting it: One of the things I found that made a difference to patients (children to adults) was saying, “I believe you.” Pain is something I can experience, but I cannot see. If someone is telling me they have pain, my job isn’t to judge or dismiss it, it is to try to help to relieve that pain. Starting off a consultation validating your patient’s feelings and pain isn’t hard to do, and makes a world of difference. As medical professionals, we can make the difference for other women and help to champion better responses to female pain. Further reading Is pain a patient safety issue? (Patient Safety Learning, November 2020) ‘Women are being dismissed, disbelieved and shut out’ (Stephanie O'Donohue, November 2020) Gender bias: A threat to women’s health (August 2020) Should mismanaged pain be considered an adverse event? (March 2015) Improving hysteroscopy safety (Patient Safety Learning, November 2020)
×