Daily Mail, Tuesday, March 3, 2020^ Page 51
E
VERY week for nearly a
year, Lorraine Shilcock
a t t e n d e d a n h o u r- l o n g
counselling session paid for
by the NHS.
She needed the therapy, which ended in
November, to cope with the terrifying
nightmares that would wake her five or
six times a night, and the haunting
daytime flashbacks which turned her into
a trembling wreck.
Lorraine, 67, a retired textile worker
from Desford, Leicester, has post-
traumatic stress disorder (PTSD) — a
condition normally associated with com-
bat veterans or victims of terror attacks.
But the grandmother of three instead
owes her psychological scars to a routine
NHS medical check, which was supposed
to help her, not leave her suffering.
In October 2018, Lorraine had a
hysteroscopy, a common procedure to
inspect the womb in women who have
heavy or abnormal bleeding.
Doctors use a device called a speculum
— also used during smear tests — through
which they insert a metal probe with a
camera on the end, called a hysteroscope,
into the cervix and womb. Gas or fluid
may also be introduced to inflate the
womb to give the specialist a better view.
The procedure is designed to check for
causes of the bleeding — such as fibroids
( a b n o r m a l g r o w t h s , u s u a l l y n o n -
cancerous, in the lining of the womb) or
smaller abnormal growths called polyps,
or cancer. It’s also used for women
experiencing fertility issues.
The 30-minute procedure, performed in
an outpatient clinic, is considered so
routine that many women are told it will
be no worse than a smear test and that, if
they are worried about the pain, they can
take a couple of paracetamol or ibuprofen
immediately beforehand.Y
ET for Lorraine, and potentially
thousands more women in the
UK, that could not be further
from the truth.
Many who have had a hysteroscopy
say the pain was the worst they haveWhy isn’t the
NHS warning
women about
an exam that
can be more
painful than
childbirth?
By PAT HAGAN
e v e r e x p e r i e n c e d , a h e a d o f
childbirth, broken bones, or even
a ruptured appendix, commonly
regarded as the most agonising
medical emergency.
Yet most had no warning it would
be so traumatic, leaving some,
like Lorraine, with long-term
consequences. But, crucially, it is
entirely avoidable.
N o w G o o d H e a l t h , w h i c h
f i r s t r a i s e d c o n c e r n s a b o u t
hysteroscopies in 2014, has been
given exclusive access to Freedom
of Information data that shows
nearly half of NHS hospital trusts
in England fail to warn patients
they could suffer severe pain.
The Campaign Against Painful
Hysteroscopy (CAPH) — which
represents hundreds of affected
women, including at least 100
diagnosed with PTSD following
the procedure — asked 131 trusts
in England whether they warned
patients that there was a risk
some could find the procedure
very painful, and what kind of pain
relief they offered.
Sixty-one admitted they did not
warn patients about the risk of
‘severe pain’.
T h e B r i t i s h S o c i e t y f o r
Gynaecological Endoscopy, which
represents consultants performing
hysteroscopies, says women should
be offered the option of having the
procedure under general or local
anaesthetic, or sedation.
But the data shows that only 25
of the trusts said they routinely
offered general anaesthetic or
intravenous sedation (where an
anti-anxiety drug is slowly injected
into a vein in the arm).
And just seven trusts use the
Royal College of Obstetricians
and Gynaecologists’ patient leaflet
— which tells patients who is most
at risk of severe pain and that theycan request a general anaesthetic.
The vast majority of trusts said
t h e y h a d n o p l a n s t o s t a r t
providing the leaflet.
The result is that some women
are left so traumatised by the pain
they experience that it interferes
with everyday life.
Lorraine, who is married to
Stephen, 70, a retired factory
electrician, went to see her GP
a f t e r e x p e r i e n c i n g p o s t -
menopausal heavy bleeding, and
was referred to her local hospital
for further investigations.
A few weeks later, she received a
letter offering an appointment for
a hysteroscopy, along with a leafletadvising her to take a couple of
painkillers before turning up —
just in case there was any pain.
There was no mention that she
could request a general^ anaesthetic
or sedation beforehand — or that
the check could be stopped if it
was too painful.
Guidance from the Royal College
of Obstetricians and Gynaecolo-
gists states that doctors should
halt the procedure if a woman
finds the pain unbearable, and
continue it at a later date under a
general anaesthetic or sedation.
This is particularly significant
for post-menopausal women such
as Lorraine — the Royal College
advises they are much more likelyto suffer pain because they tend to
have tighter cervixes.
This also applies to women who
have not had children and women
who have had traumatic smears or
a previous painful hysteroscopy.
Lorraine says the agony began
as soon as the doctor tried to
insert the probe.
‘It was the most excruciating
pain I have ever felt — and I have
had two children,’ she says.
‘I felt sick and faint as the doctor
tried to force the probe into my
uterus. The pain shot all the way
u p t h ro u gh m y bo dy t o m y
shoulders and neck.’
After five agonising minutes, a
n u r s e t e n d i n g t o L o r r a i n e
suggested the doctor stop the
procedure as she was in so much
distress, which they did.
‘Afterwards, they left me
on my own to get dressed,
but I sat there in a state of
total shock,’ says Lorraine.
‘I couldn’t stop crying.
‘Stephen was just the
other side of the screen,
but I was so traumatised I
c o u l d n’ t e v e n c a l l o u t
his name.
‘When he did see me,
he was horrified at
the state I was in.’
The check lasted
long enough for the
doctor to identify
that Lorraine had
p o l y p s i n h e r
u t e r u s , w h i c h
were causing the
bleeding. She
was told she
would need to
h a v e t h e m
r e m o v e d a t a
later date.
But that was farfrom the end of her problems. In
the weeks following she began to
experience nightmares, waking up
to six times a night in a state of
utter terror.
‘I would dream that I was back
in hospital having the procedure
and racked with pain. Some nights
I would wake up screaming, sweat-
ing and with my heart racing.
‘ T h e n , d u r i n g t h e d a y, I
started getting flashbacks of the
examination. They would come
out of the blue.
‘On one occasion I was in the
queue for the tills at Ikea and had
a sudden flashback. I burst into
tears and ran out of the store.’
Lorraine’s GP diagnosed PTSD
and referred her for cognitive
behavioural therapy to teach her
ways to deal with the nightmares,
such as visualising a pain-free
outcome to the procedure.
After nearly a year of
counselling, her nightmares
reduced to three or four
times a week.
‘ I w a s s t i l l g e t t i n g
flashbacks ten times a day,’
she says. ‘I’ve been told by
my counsellor that they
will probably never go
away completely.’
Every year, 10,000
women have hys-
teroscopies on
the NHS.
T h e R o y a l
Co l l e g e o f
Obstetricians
and Gynaecol-
o g i s t s s a y s
on l y 1 0 p e rcent will experience moderate to
severe pain during an outpatient
hysteroscopy, but campaigners
argue that the figure is closer to
2 5 per cent
But even if it is only 10 per cent,
why is the NHS denying women
the right to adequate pain relief?
A general anaesthetic carries a
degree of risk but, as Good Health
has reported in the past, there is
another factor at play, with cash-
strapped hospitals encouraged
to do more procedures in an
outpatient setting to save money.
An outpatient hysteroscopy
costs around £197. But a day case
involving a general anaesthetic or
sedation costs nearly £1,000.
The Government also financially
rewards hospitals that boost
the proportion of outpatient
hysteroscopies to at least 70 per
cent. The national average is
thought to be around 60 per cent.
Campaigners want these cash
incentives scrapped and doctors
routinely to record pain scores
during an examination, so it
can be stopped before women
needlessly experience severe pain,
then rescheduled to be performed
with full-scale pain relief.
Katharine Tylko, of CAPH, says:
‘Doctors are under pressure to do
this procedure in an outpatient
setting. It means some are inclined
to continue doing it when they
should really stop.’
Lorraine says: ‘This barbaric
process should not be happening.
‘I have two daughters and I
dread the thought of them ever
having to go through what I did.’
n CAPH is conducting a
survey to gather more women’s
experiences of the procedure
at hysteroscopyaction.org.ukTraumatised:
Lorraine
Shilcock8
Teaspoons of blood lost
during the average period
Picture: GeTT y / isTockPhoTo