Hysteroscopy Procedure Triggers Trauma for Woman, Highlighting Concerns for 60,000 Annually

For Dawn Lord and her husband, Steve, a recent overnight stay in the Lake District marked something of a milestone. The getaway—the kind of trip the couple used to take often—was the first time in two years that Dawn felt well enough to leave their home in Hartlepool since a routine medical procedure caused her such intense pain and trauma that it triggered a breakdown. Like around 60,000 women in the UK each year, Dawn underwent a hysteroscopy in May 2023—a procedure to look inside the womb, which the NHS generally regards as routine and low risk. The procedure is used to investigate polyps (a benign growth in the womb), unexplained bleeding, and causes of infertility. It involves a speculum being used to hold open the vagina, then a hysteroscope (a telescope-like device, with a camera and light) being inserted through the cervix (the neck of the womb—a narrow space, which can sometimes be very rigid)—before fluid is pumped inside to distend the womb to make it easier to see what's going on. All of which can trigger pain. However, hysteroscopy is typically performed in outpatient clinics (rather than staying in hospital)—often without pain relief. Yet one in three women experience severe pain during a hysteroscopy, rating it at least seven out of ten, according to the Royal College of Obstetricians and Gynaecologists. At no point was Dawn warned about this. 'I went in thinking it was just a regular check,' recalls Dawn, 52, a mother of one. 'I wasn't advised to take anything beforehand, not even paracetamol. But it ruined my life for almost two years.'

Dawn had been referred to hospital after a routine blood test showed raised CA125 levels—a possible indicator of ovarian cancer—and after scans revealed a polyp, her consultant wanted to examine the area with a camera. 'I never imagined I'd be howling in pain. It was like being knifed.' Dawn Lord says her hysteroscopy 'ruined my life for almost two years'

Like around 60,000 women in the UK each year, Dawn underwent a hysteroscopy in May 2023 (picture posed by models)

What followed, she says, was unlike anything she'd been prepared for. Dawn recalls: 'On the day, before the procedure, the consultant said I might feel a bit of cramping. 'I never imagined I'd be howling in pain. It was like being knifed; the pain went right through my body, into my womb and my bottom. It was so intense I felt my back lift off the bed.'

This month, the House of Commons' Women and Equalities Committee published a damning report in which it attacked the lack of progress on 'the problem of painful gynaecological procedures, such as hysteroscopies and some intrauterine device contraceptive coil fittings'. The committee described 'women's harrowing, painful experiences of [these] procedures' as being 'one of the most troubling aspects' of their inquiry into women and girls' menstrual health. About 20 minutes into her hysteroscopy, with Dawn now crying for something to end the pain, the consultant agreed to inject a local anaesthetic into her cervix. But the knife-like pain persisted. Eventually, she was offered gas and air—Entonox, often used in childbirth—but it hardly helped. By then the 45-minute procedure was almost over. Afterwards, Dawn was left shaking, only able to walk clinging on to husband Steve for support. 'The consultant told me my cervix was tight and that sometimes pain just happens,' says Dawn. The pain lingered for weeks, leaving her bedbound. She also bled for several weeks (normally, if there is bleeding it lasts no more than a couple of days). Her GP prescribed antibiotics in case it was an infection, as well as a range of strong painkillers. But the shock of it all left Dawn in a permanent state of anguish. 'I felt so low I couldn't do anything,' she told Good Health, describing being incapable of mustering the energy to move around the house, let alone leave it, for months after. In short, she reflects, she felt 'broken' by the experience. Dawn believes there's a lingering assumption among healthcare professionals that women who've experienced childbirth—she has one son—will find gynaecological procedures tolerable. She also feels certain she could have been spared her ordeal had she been offered adequate pain relief in good time.

The Campaign Against Painful Hysteroscopy has become a voice for thousands of women who have endured procedures they describe as physically and emotionally traumatic. The group has amassed 8,000 testimonies, many of which mirror the experience of Dawn, a woman whose story highlights a troubling pattern: women often being denied information about pain relief or told that hysteroscopy is not painful. "I was told it would be fine," Dawn recalls. "But it wasn't. I felt completely unprepared." Her account is echoed by others who say they were left to suffer in silence, with no clear guidance on how to manage discomfort.

Dr. Mehrnoosh Aref-Adib, a consultant obstetrician and gynaecologist, has spent years studying these procedures and their impact on patients. She says the medical community often underestimates the pain associated with routine gynaecological exams. "There's an assumption that certain procedures are well tolerated," she explains. "But this can lead to unrealistic expectations for both patients and doctors." For many women, the reality is far more complex. Pain is not a one-size-fits-all experience. Hormonal changes, pre-existing conditions, and psychological factors like anxiety all play roles in how pain is perceived and managed. A woman with endometriosis may find a simple smear test agonizing, while another might barely feel it.

This disconnect between medical practice and patient experience has real-world consequences. Low uptake rates for cervical and breast cancer screenings, both critical for early detection, suggest that fear of pain may be deterring women from attending appointments. In England alone, over five million women are not up to date with their cervical screenings, according to 2024 data. A YouGov survey found that 42% of women found smear tests painful, and a fifth of those invited for mammograms said they preferred not to attend because of the anticipated discomfort. "Pain is subjective," Dr. Aref-Adib says. "But when it's not acknowledged, it can lead to long-term harm."

For Dawn, the aftermath of her hysteroscopy was years of physical and emotional struggle. "A nurse told me later that I should have been offered pain relief," she says. "That was incredibly frustrating. I felt dismissed." Her experience is not unique. Many women report feeling pressured to endure discomfort without being given options. Dr. Jennifer Byrom, a consultant gynaecologist, agrees that clinicians often overlook the psychological aspects of these procedures. "Anxiety can make pelvic muscles tense," she explains. "That tension can turn a routine exam into something excruciating." She stresses that doctors must create an environment where women feel safe to express their concerns. "We need to stop telling patients to 'grin and bear it.' Pain relief should be a standard option, not an afterthought."

The issue extends beyond gynaecological exams. Mammograms, for instance, involve compressing the breast between two plates to capture images, a process that can be painful for many women. Professor Daniel Leff, a consultant breast surgeon, acknowledges this pain is often unavoidable but emphasizes the importance of communication. "Compression is necessary for clear images," he says. "But patients should be informed about what to expect and given options to manage discomfort." Yet, as with other procedures, the lack of transparency can leave women feeling powerless.

The Campaign Against Painful Hysteroscopy argues that systemic change is needed. They advocate for better education for both patients and healthcare professionals, as well as the development of less invasive techniques. "Women deserve to be heard," says Dawn. "I didn't feel listened to when I was in the hospital. That's why I'm speaking out now." Her story—and those of thousands like her—underscore a broader challenge: in an era of advanced medical technology, why are so many procedures still causing unnecessary suffering? The answer lies not just in innovation but in empathy, transparency, and a willingness to listen.

The experience of undergoing a mammogram can be a source of significant discomfort for many women, with factors ranging from physical positioning to physiological sensitivity playing a role. According to Professor Daniel Leff, a consultant breast surgeon at the King Edward VII's Hospital in London, 'Compression during the procedure—combined with individual breast sensitivity and positioning—is the main cause of pain and tenderness.' He explains that breasts are naturally more sensitive before a woman's menstrual period, while a cold examination room or sudden contact with cold surfaces can further amplify this sensitivity. 'Small breasts can sometimes be more painful,' he adds, 'as there is less tissue to distribute the pressure between the plates.'

To mitigate this pain, Professor Leff recommends timing the appointment for seven to 14 days after a period, when breast tenderness is typically reduced. He also advises taking paracetamol or ibuprofen 30 to 60 minutes beforehand, wearing a two-piece outfit to minimize exposure, and requesting a warm room or a technologist who warms the paddle first. 'If discomfort persists,' he emphasizes, 'alternative imaging methods like ultrasound or MRI scans may be viable options. In private settings, mammograms with separate foot controls can allow women to manage the compression themselves.'

Meanwhile, the insertion of an intrauterine device (IUD)—a small, T-shaped contraceptive placed in the uterus—also presents challenges. Around 45,000 IUDs are fitted annually in the UK, with the procedure typically taking five minutes, though complications like a narrow cervix or fibroids can extend it to 20 minutes. Dr. Aref-Adib notes that pain relief is not routinely offered during the process. 'A speculum is used to access the cervix,' he explains, 'but this can be uncomfortable, particularly for postmenopausal or breastfeeding women, whose oestrogen levels affect tissue elasticity and blood flow.'

The procedure becomes more complex when the cervix is rigid, requiring dilation instruments that some women describe as 'intensely painful.' This can trigger a 'visceral' reaction, leading to nausea or cramps similar to those during labour. Once the IUD is in place, the uterus may briefly contract, mimicking period pain. Dr. Aref-Adib suggests that inserting the speculum during a woman's period—when the cervix is slightly open—can ease the process. Taking paracetamol and ibuprofen an hour beforehand, using a local anaesthetic gel, or requesting a small injection to numb the area are also options. 'Some clinics offer gas and air,' he adds, 'and newer instruments using gentle vacuum-like suction are being trialled to reduce pain and bleeding.'

For smear tests, which screen for human papillomavirus (HPV) in women aged 25 to 64, discomfort can vary widely. Dr. Lucy Hooper, a GP specializing in obstetrics and gynaecology, notes that endometriosis or other chronic pelvic pain conditions can alter how nerve endings perceive pain. 'It may be harder to locate the cervix if the uterus is tilted backwards,' she explains, 'a detail often discovered through previous pelvic scans or examinations.' Dr. Byrom, another specialist, emphasizes the importance of speculum size: 'I use smaller speculums for women who haven't had children, for example.' She also urges women with a history of painful procedures or pelvic pain to communicate this to their healthcare provider. 'If you've had a painful experience before,' she says, 'whether with a cervical smear or previous coil fitting, it's crucial to share that information.'

But why do these procedures evoke such varied reactions? Is it purely a matter of anatomy, or do psychological factors play a role? The answer likely lies in a complex interplay of physiology, individual pain thresholds, and the environment in which the procedure is performed. Whether it's the cold of a mammogram room, the pressure of an IUD insertion, or the intrusion of a speculum during a smear test, the experience is deeply personal. Yet, as the experts suggest, small adjustments—timed appointments, pain relief, and patient advocacy—can make a significant difference. Can healthcare systems do more to address these concerns? The data suggests that while progress is being made, there is still room for improvement in ensuring these procedures are as comfortable as possible for all patients.

Women should know they can ask their specialist what size speculum they are using and express concerns." Whatever a woman's history, "stretching can feel sharp, especially if you're tense or the speculum isn't a perfect fit," adds Dr. Sachchidananda Maiti, a consultant gynaecologist and obstetrician at the private Pall Mall Medical centre in Manchester. The physical and psychological dimensions of cervical screening have long been under-discussed, yet recent advancements and expert guidance are reshaping how these procedures are conducted. Researchers at Addenbrooke's Hospital in Cambridge are trialling a method that involves lifting the top few layers of cells from the cervix onto a 2.5cm absorbent disc of paper rather than scraping them off, to reduce pain. This innovation, which prioritizes patient comfort without compromising diagnostic accuracy, reflects a broader shift in healthcare toward minimally invasive techniques. For those who find smears painful or stressful, requesting a double appointment to allow for extra time is a critical step. Similarly, informing the GP practice of prior pain experiences or conditions such as endometriosis or vaginismus can ensure tailored care. Dr. Maiti emphasizes that "going slowly, explaining each step, stopping if you ask and using vaginal oestrogen before the test in the case of menopausal dryness can make a big difference." These measures underscore the importance of patient-centered communication in clinical settings.

Last June, the Department of Health announced it will automatically send out self-testing kits to women who haven't responded to smear screening invitations for six months. This initiative, which places control directly in the hands of patients, involves a swab inserted a short way into the vagina (not as far as the cervix), rotated for ten to 30 seconds, and then placed in a collection tube for laboratory analysis. While self-testing offers convenience, it also raises questions about accessibility and adherence to guidelines, particularly among populations with limited health literacy or prior negative experiences. The NHS, however, has reaffirmed its commitment to providing alternative options, including intravenous sedation or general anaesthesia, though availability varies by clinic. Not all NHS facilities offer these services, necessitating referrals to specialized units. Some clinics have adopted the "vaginoscopic" technique, which uses mini, flexible hysteroscopes and avoids the use of a speculum entirely, inserting the camera into the vagina without clamping the cervix. This approach, while less common, highlights the diversity of clinical practices aimed at minimizing discomfort.

The pain associated with hysteroscopy—used to examine the womb for polyps or causes of infertility—typically occurs as the camera (usually less than 4mm) enters the uterus and saline solution is injected to dilate it. "This can lead to the uterus reacting, causing intense period-like pains," explains Dr. Michelle Swer, a consultant gynaecologist at St George's University Hospitals NHS Foundation Trust and London Gynaecology. Pain management strategies, such as taking paracetamol or ibuprofen an hour before the procedure, are widely recommended. For more severe cases, codeine or stronger analgesics may be required. Dr. Swer stresses the importance of informed consent, noting that women should be made aware of their right to request a light anaesthetic or even general anaesthesia. However, access to these options remains uneven, with some clinics lacking the infrastructure or staffing to accommodate such requests. In such instances, GPs may prescribe diazepam prior to an examination to alleviate distress, though patients are encouraged to discuss this openly with their providers. These measures reflect a growing recognition of the need to balance medical necessity with patient autonomy and comfort.