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In this interview, researcher Zara Ward tells us about her latest project looking at adverse experiences of intrauterine device (IUD) fittings, removals and cervical smear tests.  Zara is seeking volunteers to take part in the research to help develop understanding of lived experiences. Find out what’s involved and how to take part…   Can you tell us a little bit about yourself? I’m a second- year counselling psychology doctorate trainee at the University of the West England. I work within a community mental health service for those with additional needs. I have a background of working within women's services for those who have experienced sexual abuse both online and offline. I have published research relating to so-called "revenge porn" and the effects this can have on those affected. I am incredibly passionate about exploring understudied areas, especially relating to the reproductive and sexual experiences of women and marginalised groups. What is the focus of your research and what led you to this area? The research focus is the adverse experiences of intrauterine device (IUD) fittings, removals and cervical smear tests. I was led into this area from my conversations with others following an adverse experience myself and being slightly floored by the lack of research and support in this area. The experiences shared within the Patient Safety Learning hub and social media were indicative that more work needed to be done. Who can take part? I am looking for adults based within the UK who have had an adverse experience relating to an IUD fitting, removal or smear test within the last two years. What would the process involve? The process would be an interview with myself via a Teams video call and would allow time for exploration of areas important to the individual. Once an interview has been completed, I shall transcribe, anonymise and analyse the interview to bring together themes across the people I interviewed. Is it confidential? It is. All information will be anonymised at the point of myself transcribing. How can people get in touch if they are interested? Anyone interested is welcome to e-mail me on: [email protected] and I would be happy to speak with them more about the process before any expectation of participation. What is your hope for the research findings? My hope for the research is to understand the lived experiences of those having adverse experiences during IUD fittings, removals and cervical smear tests and provide recommendations relating to mental health support. Related reading on the hub My experience of an IUD insertion: frozen with shock - no one was asking if I was OK Gynaecology procedures: patient survey example One hour with a women's health expert and finally I felt seen Fitting coils: developing a safe and supportive service Medical trauma from IUD fitting: it’s not just five minutes of pain for five years of gain

Patient Safety Learning stands with others around the world to celebrate International Women’s Day (8 March). The campaign theme for 2025 is ‘Accelerate Action’ and is a worldwide call to acknowledge strategies, resources and activity that positively impact women's advancement. In this blog, we explore four key areas of patient safety relating to women’s health, where we believe action needs to be accelerated: Pain management. Waiting times for elective gynaecology care. Redress for harmed patients. Disparities in maternal outcomes. Pain management Evidence shows that women are in pain more often and more severely than men.[1,2] They are also more likely to have their pain dismissed or underestimated[3], with racial biases leaving Black women particularly vulnerable.[4] These inequities can prolong women’s suffering of both acute and chronic pain, and can lead to delays in diagnoses and treatment. Women’s pain is dismissed in areas of healthcare relevant to both men and women, for example cardiology,[5] as well as in areas specific to the female body, for example gynaecology or maternity.[6] At Patient Safety Learning, we have heard too many accounts of patients attending gynaecology procedures where they have experienced unexpected high levels of pain that has not been managed or responded to appropriately.[7,8,9,10] In many cases, these experiences have led to an erosion of trust in the healthcare system and an increased anxiety in attending future appointments that may play a critical role in their outcomes. There is no nationally adopted, standardised patient feedback collection around pain experiences in gynaecology procedures. If patient-reported outcome measures were routinely collected, this data could be used by healthcare organisations to help identify the scale of harm and amplify the voices of the women affected so that pain is better managed and no one is at risk of trauma. These feedback mechanisms need to be co-designed with those who have lived experience to ensure the data being captured is meaningful, is designed to identify inequalities and used to improve care for all women. Most importantly, whatever the setting, it is critical that women’s experiences of pain whether chronic or acute, are listened to, believed and appropriately responded to. Patients should be empowered with the information, compassion and respect needed to place them at the heart of the decision making around their pain management. Waiting times for elective gynaecology care A 2022 report from the Royal College of Obstetricians and Gynaecologists showed the number of women waiting over a year for elective gynaecology care in England had increased from 66 before the pandemic to nearly 25,000.[11] Their follow up report in 2024 showed that waiting lists had worsened in all parts of the UK, with those living in areas of deprivation most likely to wait longest.[12] With debilitating conditions like endometriosis, already notorious for taking many years to diagnose,[13,14] evidence of continued setbacks in this area, rather than progress, is devastating. Women seeking help and treatment for life-limiting symptoms are being left without the support they need and fearful that their health will worsen. This often has a negative repercussion on other areas of life, including relationships, work and mental health.[15] The Women’s Health Strategy published in 2022 sets out plans for the roll-out of women’s health hubs to provide a ‘one-stop shop’, where services are centred on women’s needs, better coordination of care and reducing the elective backlog.[16] The Strategy notes the wide and varied range of stakeholders that will need to be involved in this effort and states that the Government” will develop a delivery plan for the commitments set out in this strategy”. However, there is currently no timetable for this, or indication of what resources may be allocated to support this work. Despite some early evidence of their success in reducing waiting times,[17] there are concerns that central support for the women’s health hubs has recently been removed,[18,19] and that women’s health has been deprioritised in the NHS health plans.[20] Women’s health needs to urgently be prioritised and invested in to address the worsening wait times for gynaecological care. Healthcare professionals must be given access to the resources needed to be able to provide high quality, safe care to all women so that inequalities do not continue to widen. Without this, patients will continue to suffer avoidable pain and are at risk of further harm relating to their physical and mental health outcomes. Redress for harmed patients Last year the Patient Safety Commissioner for England published The Hughes Report, which sets out options for redress for those who have been harmed by valproate and pelvic mesh.[21] Patient Safety Learning believes, like many individual patients and patient groups, that there must be redress options for patients harmed by the interventions covered by The Independent Medicines and Medical Devices Safety (IMMDS) Review.[22] There is considerable evidence that for many patients the clinical negligence route is simply not viable. In the absence of any system of redress, this leaves them with no assistance to help meet the cost of any additional care and support they may need. We also believe that redress should extend to those affected by hormone pregnancy tests, who fell outside of the scope of The Hughes Report’s recommendations. Excluding patients and family members affected by hormone pregnancy tests from redress is not acceptable or in keeping with the spirit of the IMMDS Review’s recommendations. We believe the Government must respond to this report promptly and take steps to deliver redress for all those affected by pelvic mesh, sodium valproate and hormone pregnancy tests as a matter of urgency. Disparities in maternal outcomes The ‘Saving Lives, Improving Mothers' Care annual reports include: data on women who died during or up to one year after pregnancy in the UK lessons learned from the UK and Ireland confidential enquiries into maternal deaths and morbidity.[23] The most recent report[24] highlights a continuation of inequalities with maternal mortality rates three times as high for women from Black ethnic backgrounds and twice as high for women from Asian ethnic backgrounds when compared to White women. The data also showed that women living in the most deprived areas of the UK and Ireland were twice as likely to die compared to those living in the least deprived areas. The report also highlighted barriers to accessing maternity care for women who had recently arrived in the UK. Many didn’t get the support they needed to understand how to register with a GP to start receiving maternity care and would present for the first time in an emergency setting. Language and literacy barriers were also evident, with patient needs being poorly assessed, recorded and met. The availability of interpreters and accessible written information was inconsistent. It is clear that a continued focus is needed to ensure disparities in maternity are better understood and addressed. All women have the right to access safe maternity care, free from racism, bias and a postcode lottery. Access to information in an accessible format that enables women to give consent to interventions and make decisions about their health and the health of their babies is also vital.[25] Translation capabilities within the health service must be prioritised and properly resourced across the board for these inequalities to be addressed. Summary There are many barriers to women receiving safe and equitable care. This blog has touched on just a few of the areas where action needs to be accelerated. We must recognise there are complex inter-relationships that compound these issues – intersectionality is an essential consideration. It is important to look at all variables in order to effectively identify the barriers and solutions to safer and more equitable care. In the coming months, we hope to see the importance of patient safety in women’s health emphasised and supported through the development of the NHS 10 Year Health Plan. The Royal College of Obstetricians and Gynaecologists has also recently launched a project to identify the most pressing unanswered questions in the health of women and people from the perspective of members of the public themselves.[26] We look forward to hearing more about their findings. We continue to await the Government’s response to the Hughes Report and to support the IMMDS Review’s recommendations for redress for those who have been harmed by valproate, pelvic mesh and hormone pregnancy tests. Helen Hughes, Chief Executive Officer of Patient Safety Learning says: “All patients have the right to access safe care, free from avoidable pain and harm. Women’s health has for centuries been side-lined and action must be accelerated now to address the inequities and barriers that continue to exist. This has to start with a focus on listening to and believing women when they share their experiences. Where harm has occurred, it is vital that we learn from the mistakes made and that this harm is appropriately responded to”. References Nurofen. Gender Pain Gap Index Report Year 3. Oct 2024. Editorial. Gendered pain: a call for recognition and health equity. eClinicalMedicine Mar 2024 Vol 69. C de C Williams, A. Analysis: Women’s pain is routinely underestimated, and gender stereotypes are to blame. The Conversation. Apr 2021. Hoffman KM, Trawalter S, Axt JR et al. Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. Proc Natl Acad Sci U S A. 2016 Apr 19;113. Nabel EG. Coronary heart disease in women--an ounce of prevention. N Engl J Med. 2000 Aug 24;343. J. H. Bamber, R. Goldacre, D. N. Lucas et al. A national cohort study to investigate the association between ethnicity and the provision of care in obstetric anaesthesia in England between 2011 and 2021. Anaesthesia, 78(7), 820-829. Patient Safety Learning - the hub. Painful hysteroscopy. Community forum - accessed 03/03/25. Patient Safety Learning - the hub. Pain during IUD fitting. Community forum- accessed 03/03/25. Cohen, L. The pain of my IUD fitting was horrific…and I’m not alone. Patient Safety Learning - the hub. Jun 2021. Anonymous. My experience of an IUD insertion: frozen with shock - no one was asking if I was OK. Patient Safety Learning - the hub. Jan 2025. Royal College of Obstetricians and Gynaecologists. Left for too long. 2022. Royal College of Obstetricians and Gynaecologists. Waiting for a way forward. 2024. Endometriosis UK. “Dismissed, ignored and belittled”. The long road to endometriosis diagnosis in the UK. Mar 2024. All Party Parliamentary Group (APPG) on Endometriosis. APPG on Endometriosis Inquiry Report 2020. Endometriosis in the UK: time for change. 2020. Royal College of Obstetricians and Gynaecologists. New RCOG report reveals devastating impact of UK gynaecology care crisis on women and NHS staff. Nov 2024. NHS England. Women's Health Strategy for England. Aug 2022. Crouch, H. Women's Health Hub aims to reduce wait lists for gynaecology. Barts Health NHS Trust. Nov 2024. Royal College of Obstetricians and Gynaecologists. RCOG responds to reports that central support for women’s health hubs will end. Jan 2025. Donnelly, L. Wes Streeting dumps women's health target from NHS plan. The Telegraph online. Jan 2025. NHS England. NHS England 2025/26 priorities and operational planning guidance. Jan 2025. Patient Safety Commissioner. The Hughes Report: Options for redress for those harmed by valproate and pelvic mesh. Feb 2024. Cumberlege, J. First Do No Harm. The report of the Independent Medicines and Medical Devices Safety Review. July 2020. The National Perinatal Epidemiology Unit, MBRRACE-UK. Saving Lives, Improving Mothers' Care annual reports. The National Perinatal Epidemiology Unit, MBRRACE-UK. Saving Lives, Improving Mothers' Care 2024 - Lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2020-22. Oct 2024. NHS England. Accessible Information Standard (updated Aug 2017). Royal College of Obstetricians and Gynaecologists. Women's Health Research Priorities (WHRP). Jan 2025. Related hub reading Top picks: Women's health inequity Dangerous exclusions: The risk to patient safety of sex and gender bias Failures of informed consent and the impact on women’s health: a Patient Safety Learning blog Gender bias: A threat to women’s health Top picks: Six resources about improving access to cervical screening The normalisation of women’s pain Top Picks: Women campaigning for patient safety TIGER UK: A new network for people passionate about improving gynaecology experiences First Do No Harm APPG public meeting on redress: Speech from Kath Sansom Fitting coils: developing a safe and supportive service

The following account has been shared with Patient Safety Learning anonymously. We’d like to thank the patient for sharing their experience to help raise awareness of the patient safety issues surrounding IUD procedures. *Trigger warning: Some people may find the following account distressing to read. Please note that experiences of pain and the care given during gynaecological procedures vary greatly. I came across Patient Safety Learning's forum page about IUD experiences after having my first Mirena coil fitting. I felt unable to comprehend the sense of violation and trauma I had just experienced. A suspected cancer referral I was referred by my GP on the 'suspected cancer pathway' for some post menopausal bleeding. On a positive note, I cannot fault the system and the speed with which I was seen, but my treatment during the appointment was so awful I am actually shaking again as I write this. Although this was an urgent referral, I was not particularly anxious as I felt the erratic bleeding I was experiencing was likely due to my hormone replacement therapy (HRT) regime. I was expecting a consultation and a scan, possibly a hysteroscopy; with a change in my HRT regime being the likely outcome. Off to a bad start The appointment started off on the wrong foot with the consultant asking if I thought there was actually any benefit in taking HRT, likening it to long term antidepressant usage. I explained that, as a runner, I was largely taking it for the well researched bone health benefits but I found his question rather belittling with its implied suggestion of menopause being all in the mind. He went on to advise that a Mirena coil would be a better option for me for HRT which I agreed I would consider. He did not explain the procedure or the possible complications or risks. I will add here that I was sterilised at the age of 30 after my second child. Contraception wasn't something I'd had to consider for the past 23 years so it wasn't really something I'd chatted about with friends. I had heard rumours of bad experiences but took it with a pinch of salt - there are after all rumours of bad experiences in all walks of life. I could not have been more wrong. The procedure - I was frozen with shock I stripped to the waist, legs in stirrups and the consultant explained he would first perform a transvaginal ultrasound to check the thickness of the endometrium - this was reassuringly normal. Then without any warning, he told me he was just going to inject some anaesthetic into my cervix and fit a coil. I had no time to prepare myself at all for this - I didn't really feel I had consented but he and both nurses in the room were acting as though this was all very normal. The injections weren't pleasant in themselves, particularly as I wasn't expecting them. There was no pause at all before I felt awful searing pain and pulling sensations, nothing was being explained prior to it being performed. Something was said about my cervix needing to be dilated and it seemed to take forever. I didn't shout out, I didn't ask him to stop, i just let the tears come. I felt absolutely frozen with shock throughout the whole procedure - no one was asking if I was OK so I assumed I was being a bit of a baby. He announced the coil was in place and I was sat up. Lack of compassion Within seconds I was flooded with heat, I wanted to be sick and everything started to go black. The nurse laid me back down and I remember coming round with a fan on my face and my feet elevated on a stool. The nurse seemed very chilled about the whole thing and just said - oh you're a fainter! I am 53 and have only ever fainted once in my life and that was over 20 years ago. The consultant did not even look at me, let alone speak. I actually felt embarrassed and just wanted to get out as fast as possible. I was slowly sat up and the nurse went and got my daughter from the waiting room. My daughter was told that I felt a little bit wobbly and suggested we go get a coffee from the hospital coffee shop, no one checked my pulse or blood pressure and they seemed keen to get on so we dutifully left. I felt horrific. I couldn't make it to the coffee shop at first. I had to sit down with my head between my legs twice in the hospital corridor as I felt so faint, sick and hot. I've no idea how I dragged myself to the cafe as I continued to feel so awful. After 30 minutes of this my daughter went to get help. She was advised to get a wheelchair and take me back to the clinic which she did. We were laughingly told by the receptionist that I wasn't the first and wouldn't be the last and that we were welcome to sit in a quiet room until I felt better. She brought me a cup of tea but no nurse checked on me at all. It took almost an hour after the fitting before I could stand for long enough to get out to the car. We just sort of slunk out and that was it. Later when I felt better, I checked my sports watch data. My heart rate had averaged 46 for over 30 minutes with the lowest reading being 38 beats per minute. Left in disbelief but inspired to advocate for change How is this happening in 2024? The thought of ever having another pelvic exam, smear test or anything else makes me feel sick and shaky. Where do people go for support with this? It's not ok. I work in Primary Care and often refer women on the same pathway I have just been through. I will absolutely be raising my concerns with the care provider involved. I also have since spoken to a number of women of perimenopausal age and have been horrified to hear so many upsetting experiences from others. It does seem that there is an embedded culture within gynaecological care within which women are neither heard nor permitted agency over their own bodies. Two weeks on and I am feeling far less traumatised, but incredibly inspired to help bring an end to this poor treatment of women. It can be easier to speak up in advocacy than solely for oneself. Share your experience Have you had a gynaecological procedure recently? Would like to share your experience - positive or negative? What makes the difference when it comes to feeling safe or unsafe when accessing these services? You can comment below (sign up first for free), or contact our editorial team at [email protected]. You can also add your experience of a hysteroscopy or IUD procedure to our community forum. Pain during IUD fitting Painful hysteroscopy Related reading Pain experiences during intrauterine device procedures: a thematic analysis of tweets (11 June 2024) Failures of informed consent and the impact on women’s health: a Patient Safety Learning blog Gynecology has a pain problem Our discomfort is routine. What if it didn’t have to be? (1 June 2022) Fitting coils: developing a safe and supportive service The ripples of trauma caused by severe pain during IUD procedures (BMJ Opinion, July 2021)

The pain and distress of not being able to see an NHS dentist are "totally unacceptable", an inquiry has told the government. A review was launched after a BBC investigation found 9 in 10 NHS dental practices across the UK were not accepting new adult patients. Some people drove hundreds of miles for treatment or even resorted to pulling out their own teeth, the BBC found. The government says it invests more than £3bn a year in dentistry. But a damning report, by the Commons' Health and Social Care Committee, says more needs to be done, and quickly. The House of Commons Committee report with recommendations to government can be viewed at the link below. The Government has two months to respond.