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Pain during gynaecological procedures
Minor gynaecological procedures are undertaken by thousands of female patients every year, but a lot of them report finding the experience painful and traumatic.
This page provides information on pain during minor gynaecological procedures and our work to improve healthcare experiences in this area.
The following information is based on the lived experiences and priorities expressed to us by our community. If you need medical/health advice, please contact a GP or medical professional. Read our medical disclaimer
What are minor gynaecological procedures and why is pain management an issue?
- ‘Minor gynaecological procedures’ are very common procedures, undertaken by thousands of female patients every year, but a significant number of them report finding the experience painful and traumatic.
- They can include fitting and removal of Intrauterine Devices (IUDs), cervical screening and associated treatment, and outpatient hysteroscopy.
- Whatever the procedure, it’s important that patients feel informed and have the best experience possible – including having their pain well-managed.
Minor gynaecological procedures are usually invasive and can include:
- IUD (Coil), sometimes referred to as ‘Mirena’, insertions and removals – where a small hormonal device to prevent pregnancy is inserted into the uterus (or removed)
- Hysteroscopy – a procedure where a small camera is used to examine inside your womb
- Colposcopy – a procedure to examine your cervix
- LLETZ (large loop excision of the transformation zone) – a treatment for abnormal cervical cells picked up through cervical screening
For information about a specific minor gynaecological procedure visit the NHS 111 information pages. More information about minor gynaecological procedures performed in your area can be found by searching for your local health board here.
Minor gynaecological procedures are usually undertaken in outpatient settings, such as GP surgeries, sexual and reproductive health clinics, or hospital day case units. They are very common, with thousands taking place every year. However, some patients report not being given enough information ahead of time to choose how and where they would like the procedure to take place.
Evidence suggests that a significant number of women undergoing these procedures experience considerable pain, and some are traumatised by their experience. Sedation, anaesthetic, and pain relief are not routinely offered in clinics performing minor gynaecological procedures.
It has also been shown that patients affected by pain, or who have felt like they’ve not been taken seriously in these settings, can be reluctant to seek healthcare again in the future. This can mean they could be at risk of not having symptoms investigated or starting treatment in a timely way.
What are we calling for?
Our overall aim is to to prevent those patients undergoing minor gynaecological procedures having painful and traumatic experiences which might deter them from seeking healthcare in the future.
Evidence suggests that women’s experiences of pain are often not taken seriously in healthcare settings, with women less likely to receive pain relief or be treated as promptly as men.
Traditionally, women’s reporting of pain (pelvic pain in particular) has been normalised and dismissed, resulting in patients sometimes being expected to endure extreme pain situations, including in clinical outpatient settings.
It can reduce costs and waiting lists for health service providers to offer many minor gynaecological procedures in outpatient settings where access to IV sedation and analgesia is not available. However, more research is needed to understand if and how far any pain and trauma experienced might result in other health issues, such as delayed help-seeking or mental health concerns.
In Wales, women are experiencing pain and trauma during minor gynaecological procedures unneccessarily. Although these procedures are important and need to be undertaken quickly, patient experiences need to be improved.
In the face of growing NHS Wales waiting lists, it is important that minor gynaecological procedures are undertaken as quickly as possible because, for some patients, they can identify and address potentially serious health issues, like cancer. However, it is important that the need for speed does not result in patients experiencing pain and trauma unnecessarily.
- Patients report not being given adequate information ahead of minor gynaecological procedures across Wales, which would help both them and their healthcare provider make better, more informed decisions about how and where procedures should take place, and who is suitable for them.
- There is inconsistent access to appropriate pain relief for patients, and how far patients can choose the best way for the procedure to be undertaken in their case. Waiting times can vary hugely across Wales.
- Patients across Wales describe differences in their being able to report back on their experiences and be confident that this will inform care in the future.
- There is often a lack of patient involvement in designing and delivering medical training so that both healthcare professionals and services better understand and accommodate their needs.
We need to:
- Raise awareness amongst healthcare professionals of patients’ experiences of pain and trauma during gynaecological procedures
- Raise awareness of the fact that many female patients will be living with painful gynaecological conditions such as endometriosis or adenomyosis, and others may have experienced trauma, so thorough history-taking (or ‘triage’) is needed, along with a more compassionate and patient-centred approach.
- Empower patients to share their stories and have their voices heard, to inform learning and clinical practice
- Encourage medical trainers and training courses in Wales to involve patients, so that their experiences are better understood and their needs met
- Encourage NHS Wales to explore a range of options for delivering gynaecological services, so that optimum and patient-centred care is at the forefront
- Support investment in research on patient experiences, shared decision making tools, medical devices, and pain management options, so that Welsh patients can expect to receive the best care available.
Our champion: Lucy C
“After a personal experience of a traumatic IUD fitting, I was left feeling gaslighted and ashamed. I reached out on social media to see if others had a similar experience, and was overwhelmed with the stories I received.
After creating a survey to collect, what I later discovered, was the only data that existed on the issue at that scale, I launched a campaign to demand that we have access to pain relief.
Some progress has been made, but it’s not enough. Women’s pain must be taken seriously and this is our medical ‘Me Too’ moment. Patients have put up with pain for far too long.”
What have we achieved?
Our campaign activity to improve the lives of those experiencing pain during minor gynaecological procedures is extensive. Some of our achievements are outlined below:
We raise awareness through events, media, training and fundraising
- We have supported our champions’ participation in media campaigns to raise awareness of pain during minor gynaecological procedures. Two examples include this ITV News article about IUD fitting and this BBC news article about hysteroscopy without anaesthetic.
We take part in consultations, advisory boards and co-production of healthcare
- We work closely with the Faculty of Sexual and Reproductive Healthcare, part of the Royal College of Obstetrics and Gynaecology (RCOG), to improve guidance and practice in Coil insertion and removal
- We work with the RCOG’s Welsh Executive Committee and Welsh National Specialist Advisory Group for Obstetrics and Gynaecology to evaluate clinicians’ practice in Coil insertion and removal
- We work with the Wales National Gynaecology Implementation Network to help develop patient-led training for outpatient hysteroscopy
- We are public partners in Wales-led research proposals to understand patient experiences of minor gynaecology procedures and develop shared decision-making tools and better communication
- We collaborate with other third sector organisations to research and campaign for improved care in clinical settings, such as the National Federation of Women’s Institutes’ work on cervical screening, the Campaign Against Painful Hysteroscopy, and Patient Safety Learning.
We engage directly with policy makers and researchers
- We ensured that patients’ experiences of minor gynaecological procedures were heard by the Senedd’s Cross-Party Group on Women’s Health
- We included evidence about minor gynaecological procedures in the Women’s Health Wales Coalition’s report to the Welsh Government
- We ensured that the Welsh Government incorporated information about female patients’ need for person-centred care in its Quality Statement for Women’s and Girls’ Health ahead of publication of the 10-year NHS Wales Women’s Health Plan.
Related news and blogs
The BMJ: Intrauterine devices (IUDs) and pain.
The BMJ Opinion: We must validate the painful experiences of many women using intrauterine devices FTWW volunteer, Lucy, and the Women’s Health Coalition were mentioned in an Opinion Piece featured in the British Medical Journal (BMJ) about the need to address women’s...
Stories about pain during gynaecological procedures
Advocating for yourself or someone else
Many women find it difficult to discuss health issues and seek support, even if these health issues are having a significant impact on their lives.
We're working with our community to develop tools and tips to help women to speak up, and provide guidance for people who would like to support their loved ones, friends, colleagues or patients who are living with health conditions.
Useful links and documents
FTWW's bi-lingual pain during gynaecological procedures leaflet
This flyer provides a brief overview of our work in this area and why it is needed
Women's Health Wales: A Quality Statement for the Health of Women, Girls and those Assigned Female at Birth 2022
Read more about our recommendations to the Welsh Government in this report by the #WomensHealthWales coalition
Outpatient Hysteroscopy (Green-top Guideline No. 59) - Royal College of Obstetricians and Gynaecologists
“The aim of this guideline is to provide clinicians with up to date, evidence-based information regarding outpatient hysteroscopy, with particular reference to minimising pain and optimising the experience of the woman or person.”
The Faculty of Sexual & Reproductive Healthcare
About Cervical Screening - NHS Wales
5 Minutes That Matter - The WI campaign
Hysteroscopy Action
Patient Safety Learning - The Hub
Information on hysteroscopy
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