Study Reveals Systemic Failings in Women's Experiences of Outpatient Hysteroscopy
A study published in the journal Women's Health has analyzed discussions on the parenting forum Mumsnet to identify common themes in patient experiences of outpatient hysteroscopy (OPH). The research was led by the University of Reading and conducted following the launch of a Mumsnet campaign called "End Medical Misogyny."
"The health system too often gaslights women, treating their pain as an inconvenience."
— Health Secretary Wes Streeting
Methodology
Researchers extracted and analyzed 4,644 posts from 261 threads on Mumsnet, posted between March 2018 and December 2024 and involving 1,971 users. The study employed reflexive thematic analysis to identify recurring themes in the unprompted conversations.
The authors note that online accounts may overrepresent negative experiences and that the findings are contextualized accounts, not representative of all patient experiences or indicative of prevalence.
Five Key Themes Identified
The analysis identified five themes related to clinical, organizational, and personal factors affecting patients' experiences:
1. Variability in Informed Consent
Patients reported receiving inadequate information to make informed choices. Posts indicated that consent was sometimes given due to fear of symptom progression or because OPH was presented as the only timely option. Some users reported difficulty in withdrawing consent due to perceived pressure or fear.
2. Patient Vulnerability
The intimate nature of the procedure was reported to make patients feel physically and emotionally vulnerable. Users highlighted a perceived power imbalance between clinician and patient. Those with a history of sexual abuse reported heightened vulnerability.
3. Inconsistency in Pain Management
Patients reported wide variations in pain management options across different NHS trusts and hospitals, ranging from general anesthetics to over-the-counter medications. This variability was described by users as fostering a sense of injustice.
4. Perceived Dismissal of Pain
Users described instances where they felt their pain was minimized or questioned by healthcare professionals. Some reported that medical records contradicted their reported experiences. The characterization of hysteroscopy as "tolerable for most" was frequently perceived by users as inaccurate.
5. Perception of Gender Bias
Users reported a perception of gender biases in medical care and historic assumptions about female pain. Concerns included the use of distraction techniques instead of effective pain relief and a normalization of female pain, which was seen as creating unequal standards of care compared to men in comparable medical situations.
Context and Recommendations
Approximately 71,000 hysteroscopy procedures are performed annually in England. The study's researchers state that the findings suggest issues extend beyond individual clinicians, potentially reflecting wider structural issues in women's healthcare.
The study calls for NHS trusts to introduce:
- Standardized consent processes
- Consistent pain management protocols
- Clinician training in trauma-informed care
"Women report going into procedures unprepared, experiencing more pain than expected, and feeling their experiences are not taken seriously."
— Susanne Cromme, lead author, University of Reading
Justine Roberts, Founder of Mumsnet & Gransnet, stated that the research indicates many women experience severe pain during hysteroscopy, compounded by unclear information, inconsistent pain relief, and lack of proper consent. Roberts described these as "systemic failings."
A Mumsnet user, Dawn Lord, described undergoing an unexpected hysteroscopy in 2023 without what she described as informed consent or adequate pain relief.