When Maria Waters, a 58-year-old GP from Richmond, Surrey, attended her hospital appointment last summer, she prepared thoroughly. She was scheduled for a hysteroscopy—an examination of the uterus using a narrow, camera-equipped telescope—after experiencing unusual vaginal bleeding to rule out cancer.
Despite referring many patients for the procedure, Maria had never undergone one herself. As a doctor, she understood its importance, even though it was known to be uncomfortable, as it is commonly performed without sedation or general anesthesia.
During a hysteroscopy, a thin camera-equipped tube is inserted into the uterus through the vagina. Saline is used to expand the womb for better visibility.
Following NHS recommendations, Maria took painkillers before the appointment and expressed concerns about discomfort. The gynaecologist reassured her that most women tolerated the procedure well, even those who hadn’t given birth.
However, the pain was far worse than she had anticipated. The repeated insertion and removal of the hysteroscope—four times in total—caused extreme discomfort. Eventually, she fainted, waking up with staff supporting her legs. The procedure, which was meant to last ten minutes, took 35 minutes as the team had to stabilize her blood pressure.
In the days following, Maria experienced heavy bleeding and abdominal cramps.
Each year, the NHS performs hundreds of thousands of hysteroscopies, with 263,572 carried out in England alone. The procedure is commonly used to investigate infertility, abnormal bleeding, fibroids, and polyps, often combined with treatments such as polyp removal.
Demand for hysteroscopies is rising, driven by an increasing number of postmenopausal women being investigated for abnormal bleeding, rising obesity rates (a risk factor for endometrial cancer), and women on HRT experiencing irregular bleeding.
In response to concerns about pain, the Royal College of Obstetricians and Gynaecologists (RCOG) issued guidelines acknowledging that while most women tolerate the procedure, a third report severe pain (7+ on a 10-point scale). The guidance states that hysteroscopists must stop if a patient requests it or if staff determine the pain is too severe.
Options for pain management include over-the-counter painkillers, local anesthesia, or sedation. If a procedure is stopped due to pain, patients should be offered alternative methods, such as spinal anesthesia or general anesthesia.
However, campaigners argue these guidelines are frequently ignored, leading to unnecessary suffering. The Campaign Against Painful Hysteroscopy has gathered data from nearly 8,000 women, revealing that:
- 83% were not warned about the risk of severe pain.
- 67% said the procedure continued even after they reported being in pain.
- 60% endured the procedure without knowing they had pain relief alternatives.
Jocelyn Lewis, co-founder of the campaign, highlights that many women (80%) were unaware they could request general anesthesia or sedation. She argues that women are often pressured into outpatient procedures without adequate pain relief, facing either excruciating pain or long delays if they insist on anesthesia.
Many women describe hysteroscopy pain as worse than childbirth, with some developing post-traumatic stress disorder (PTSD) afterward. Some are so traumatized that they avoid sex or even routine gynecological exams, including smear tests—potentially delaying life-saving cancer diagnoses.
Alix Marijan, 53, an operations manager from West London, found her hysteroscopy last summer so traumatic that she would only undergo it again with general anesthesia. Initially unfazed by the prospect, she was unprepared for the excruciating pain.
“The doctor kept removing and reinserting the tube multiple times. I felt dizzy, nauseous, and close to passing out,” she recalls.
Despite having a high pain tolerance, Alix was left bent over in agony, shivering, and vomiting after the procedure. Months later, she still feels traumatized.
“I refuse to be gaslighted into believing I’m overreacting for requesting pain relief,” she says. “If this procedure were performed on men, a general anesthetic would be standard.”
The Campaign Against Painful Hysteroscopy is not calling for the procedure to be discontinued but for genuine choice and proper pain management.
While some experts defend outpatient hysteroscopies, a 2019 audit of 5,000 British women found that most managed the pain. However, campaigners argue that the experience of those who suffer severe pain must not be ignored.
Following ongoing complaints, the RCOG updated its guidance in 2023, emphasizing the use of narrower hysteroscopes and lower fluid pressure.
Gynaecologist Geeta Kumar stresses that while hysteroscopies are vital for diagnosis and treatment, they should not be traumatic. Patients must be fully informed about pain relief options.
An NHS spokesperson reaffirmed that no patient should have to endure unnecessary pain and urged clinicians to follow the latest RCOG guidelines.
While hysteroscopies remain a crucial diagnostic tool, campaigners insist that until pain management is taken seriously, women will continue to suffer needlessly—risking not only their physical well-being but also their trust in gynecological care.
