Every year, more than 70,000 hysteroscopies are performed in England alone. The National Health Service (NHS) classifies these procedures as "high volume low complexity" outpatient interventions. However, a significant number of patients are reporting experiences of severe, traumatic pain, inadequate pain relief, and medical staff who dismiss their physical suffering.
In February this year, Beth Harris waited in the day surgery unit of her local hospital for a hysteroscopy to remove a uterine fibroid. The procedure involves inserting a thin surgical instrument equipped with a lens, light, blade, and an irrigation system that pumps saline solution through the vagina and cervix into the womb. The saline expands the womb so the fibroid can be shaved away. Although Harris followed hospital advice to take paracetamol or ibuprofen an hour before her 1:00 PM appointment, she was still waiting in her gown at 4:00 PM.
This was Harris's third hysteroscopy. Her first two had been diagnostic examinations of her womb lining, which had thickened as a result of years of breast cancer medication. Having found the first two procedures highly painful, she explicitly asked her gynaecologist if the fibroid removal would hurt. The consultant assured her that she would receive a local anaesthetic and "wouldn't feel anything," comparing the experience to "going to the dentist."
While waiting, Harris observed the two patients treated ahead of her. The first woman emerged hysterical, requiring the consultant to intervene. The second collapsed in the recovery room and was left unattended until a random patient in a gown and slippers alerted a nurse, who eventually wheeled her away on a trolley.
When Harris was finally called into the theatre, she found a casual environment where the gynaecologist, nurses, and an inactive anaesthetist chatted amongst themselves. The gynaecologist administered a local anaesthetic injection near her cervix but proceeded immediately without waiting to see if the block had taken effect. Harris described the injection itself as painful, but the subsequent procedure, with a spinning blade inside her womb, was excruciating. She described the physical pressure and manipulation as "barbaric" and felt as though she had been assaulted. She left the theatre sobbing, only to be placed in a recovery room that offered no dignity or privacy.
The campaign group Hysteroscopy Action (HA) has spent 16 years advocating for patients to receive comprehensive information regarding the risk of severe pain and a full range of pain relief options, including local anaesthesia, gas and air, conscious sedation, epidurals, and general anaesthetic. Katharine Tylko, a founding member of the group, emphasized that they are seeking parity with colonoscopy patients, half of whom are men. While the Women's Health Strategy announced in April by then Health Secretary Wes Streeting included Action 7—which called for informed consent and pain relief choices for hysteroscopies—Tylko says there has been only silence since the announcement.
Hysteroscopies are the primary diagnostic tool recommended by the National Institute for Health and Care Excellence (NICE) guidelines since 2018 for investigating heavy or unexplained vaginal bleeding, helping to rule out endometrial cancer. They are also used to investigate unexplained infertility, recurrent miscarriages, and to remove polyps, fibroids, or scar tissue. Historically performed under general anaesthetic, the procedures shifted to outpatient settings in the 2000s and 2010s after clinical audits deemed them safe and cost-effective. Current NHS targets mandate that 90% of diagnostic and 50% of operative hysteroscopies occur in outpatient environments, where pain management often relies solely on a nurse offering conversational distraction.
Tylko, a 71-year-old musician and translator, underwent a hysteroscopy 23 years ago for heavy bleeding that was eventually diagnosed as late-stage womb cancer. Her GP had delayed referring her, suggesting Tylko would "freak out" at an NHS gynaecology clinic because she had never given birth—meaning her cervical canal had not been stretched—and because she found smear tests difficult due to what she now knows was undiagnosed endometriosis. Tylko eventually had her procedure privately under general anaesthetic. During her subsequent cancer treatment, she met numerous other women who had been traumatized by outpatient hysteroscopies, challenging the clinical narrative that only a tiny fraction of patients experience difficulties.
More than 13,000 women have completed HA's online survey, and its petition has gathered nearly 70,000 signatures. In 2020, a benchmark multicentre study revealed that the average pain score for outpatient hysteroscopies was 5.2, which is categorized as moderate pain that would justify codeine on a hospital ward. Furthermore, 35% of the women surveyed reported a severe pain score of seven or higher. Richard Harrison, a lecturer and pain research co-lead at Reading University, notes that outpatient hysteroscopies have a failure rate of approximately 10%, with pain being the primary cause. This failure, he warns, can cause patients to disengage from future, potentially lifesaving medical procedures.
Harrison, who recently co-authored a study analyzing data from nearly 5,000 hysteroscopy patients, links these findings to the broader gender pain gap, where women's pain is statistically undertreated. The study identified a pattern of "gynaecological pain gaslighting," with patients frequently told that the procedure "can't be that bad" and that "most women tolerate this procedure well."
To document this treatment, 56-year-old Helen Garnett from North Lincolnshire secretly recorded her outpatient hysteroscopy and posted the audio online with altered voices. Having nearly fainted during two previous hysteroscopies, Garnett had requested pain relief in advance from her GP and clinic, only to be told she would discuss it on the day of the procedure. The recording shows her repeatedly but politely asking for pain relief, only to be bypassed while nurses offered patronising comments, such as offering to sing to her. Garnett described the physical sensation as having a knife swept around inside her, leaving her feeling childishly diminished and in tears.
Some clinicians acknowledge the need for reform. Dr. Gail Busby, a consultant gynaecologist with 26 years of experience, admitted that gynaecologists were historically focused on the technical aspects of the procedure and assumed the pain was merely period-like cramping. She acknowledged that it is now undeniable that some women experience severe pain and must be listened to.
For Beth Harris, these realizations come too late. She has chosen to undergo a hysterectomy to ensure she never requires another hysteroscopy, and is currently on a waiting list to see a psychologist to manage the panic and anxiety she now experiences at every medical appointment.
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