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.
This is something grassroots group the Campaign Against Painful Hysteroscopy has heard from thousands of women.
To date, it has gathered 8,000 testimonies of women with shocking stories that echo Dawn’s – many report not being informed that a hysteroscopy can be painful or being given information about pain relief options.
Dr Mehrnoosh Aref-Adib, a consultant obstetrician, says ‘pain may be underestimated’
Such experiences speak to a wider question: in an age of modern medicine, why are many procedures on women, from smear tests to mammograms, still so painful?
It could explain the relatively low uptake among women for cancer screening – tests and checks that save thousands of lives each year.
More than five million women in England are not up to date with their routine cervical screenings, for instance, according to 2024 data. Like hysteroscopy, cervical screening also involves a speculum being used to hold open the vagina to access the cervix. A YouGov survey last year of 3,000 women found 42 per cent found it painful.
And just 63.6 per cent of women invited for mammograms to screen for breast cancer in England attended last year (2024/25).
An NHS survey of 2,000 women last year found that a fifth of women said they preferred not to have a mammogram as they’ve heard it’s painful.
Pain is hugely individual and subjective – and there are multiple factors that alter a woman’s experience of a procedure.
For example, a drop in the hormone oestrogen after the menopause means vaginal tissue can be thinner and drier, making the insertion of a speculum more painful. Scarring (from childbirth or previous surgery, for instance) or pre-existing conditions, such as endometriosis or Crohn’s disease, can alter how pain signals from nerves in the pelvic area behave.
In other words, what some women experience as no big deal, can be intensely painful for others.
‘There can be an assumption that certain procedures are generally well tolerated,’ says Dr Mehrnoosh Aref-Adib, a consultant obstetrician and gynaecologist at Whipps Cross NHS Hospital and the private London Gynaecology practice.
‘While some patients feel little or no discomfort, this can result in unrealistic expectations of patients and doctors,’ she adds. ‘I often find it hard to predict who will find something painful. When this variation is not fully recognised, pain may be underestimated.’
Dr Jennifer Byrom, a consultant gynaecologist at Birmingham Women’s Hospital and Priory Hospital in Edgbaston, agrees that women’s pain associated with routine procedures is sometimes underestimated by clinicians.
She adds that a further consideration is that women may feel anxious or even embarrassed about intimate procedures.
‘If a woman is anxious, she’ll be tense in the pelvic floor [muscles that span the bottom of the pelvis and support the bladder, bowel and womb] – and this could make it uncomfortable to be examined,’ she explains.
‘This is why the culture needs to change, so that women don’t feel they should grin and bear it. Doctors need to make clear that pain relief options are available.’
For her part, Dawn has since learned she should have been offered pain relief in advance.
‘A nurse I spoke to a few days afterwards told me this, which was incredibly frustrating,’ she says. ‘I’ve since complained to the hospital and they apologised.
‘It’s taken me two years to feel anything like myself again – and that’s just because of the passing of time. Women need to be listened to, not dismissed, as I was.’
Here, with the help of top experts, we look at procedures many women undergo that can cause pain – and how to minimise it.
Professor Daniel Leff, a consultant breast surgeon at the King Edward VII’s Hospital in London, says that compression during a mammogram can cause pain
Mammograms
These low-dose X-rays detect early signs of breast cancer and are routinely offered to women aged 50 to 70 in the UK in a national screening programme.
Each breast in turn is compressed between two parts of the machine – known as the paddle and the plate. The breast is placed on the plate, and the paddle descends from above to flatten the tissue for a few seconds so images can be taken from different angles.
It needs to be tight to produce clear images, which are vital to detecting cancer, particularly early-stage cancers.
‘That compression – plus individual breast sensitivity and positioning – is the main cause of pain and tenderness,’ explains Professor Daniel Leff, a consultant breast surgeon at the King Edward VII’s Hospital in London.
‘Breasts are also more sensitive before a woman’s period, while a cold examination room and sudden exposure to cold surfaces can increase sensitivity.’
Small breasts can sometimes be more painful as there is less tissue to spread between the plates.
HOW TO IMPROVE IT: Time the appointment – if it’s not urgent – for seven to 14 days after a period, when breasts are usually less tender, says Professor Leff.
‘Take simple pain relief [paracetamol or ibuprofen] 30 to 60 minutes before, wear a two-piece outfit so only the top is removed – and ask for a warm room or for the technologist to warm the paddle first,’ he adds.
Also tell them if you’re tender, ask for gradual compression breaks, or repositioning if uncomfortable. If it’s still too painful, ultrasound or MRI scans may be other options.
Mammograms with separate foot controls (available privately) may help women control the level and pace of compression themselves.
The coil
A coil – or intrauterine device (IUD) – is a small, T-shaped contraceptive placed inside the womb. Around 45,000 coils are fitted every year in the UK.
The procedure should take around five minutes, but in complicated cases – for example, a narrow cervix or having fibroids [benign growths] – it can take up to 20 minutes. Pain relief is not routinely offered.
A speculum is used to access the cervix. ‘This itself can be uncomfortable depending on a woman’s oestrogen levels [because the hormone helps tissue thickness, as well as elasticity, lubrication and blood flow],’ says Dr Aref-Adib.
‘That’s why postmenopausal women or breastfeeding women can find it more painful.’
The coil is then inserted through the cervix. Sometimes, if the cervix is too rigid, other instruments are used to dilate it – some women find this intensely painful. This can lead to what’s known as a ‘visceral’ reaction, triggering nausea or labour-like cramps. Once the coil is in place, the uterus may briefly contract – a feeling like period pain. (Removal tends to cause less discomfort, though it still requires a speculum.)
HOW TO IMPROVE IT: Inserting the speculum can sometimes be easier during a woman’s period when the cervix is already slightly open, says Dr Aref-Adib.
Taking paracetamol and ibuprofen about an hour before the procedure can help with cramping. It’s also possible to use a local anaesthetic gel and, if the cervix needs to be held steady, a small anaesthetic injection can numb the area. Ask if these are available.
Dr Aref-Adib says: ‘Some clinics might offer gas and air. There are also newer instruments being trialled which hold open the cervix with a gentle vacuum-like suction, so reducing potential pain and bleeding.’
Dr Byrom adds: ‘If you’ve had a painful experience before – whether a cervical smear or previous coil fitting – or have pelvic pain or pain during sex, then tell the person doing the fitting.’
Smear test
This five-minute procedure is used to detect human papillomavirus, or HPV, which can cause cell changes in the cervix that may develop into cancer – it’s offered to women aged 25 to 64 in the UK.
A nurse or doctor would use a speculum, then a brush is used to collect cells from the cervix – which are sent for testing. It’s usually done without pain relief.
The level of discomfort varies widely, explains Dr Lucy Hooper, a GP at Coyne Medical in London who specialises in obstetrics and gynaecology.
Dr Lucy Hooper says endometriosis can affect how nerve endings sense pain
‘It may be harder to locate the cervix if the uterus is tilted backwards [you might only know this from a previous pelvic scan or examination].
‘Endometriosis and other causes of chronic pelvic pain can also affect how the nerve endings sense pain, as the nerves themselves may be damaged,’ she adds.
HOW TO IMPROVE IT: Dr Byrom says the size of the speculum used is crucial.
‘I have a selection of speculum sizes and would use a small one in particular on women who haven’t had children, for instance,’ she explains. ‘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.
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.
If you find smears painful or stressful, request a double appointment to allow for extra time. And tell the GP practice if you’ve had pain before or suffer with conditions such as endometriosis or vaginismus (where muscles tighten involuntarily).
Dr Maiti adds: ‘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.’
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.
The swab is 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 and sent to a lab.
Hysteroscopy
The pain from a hysteroscopy – used to examine the womb for polyps or causes of infertility – usually happens as the camera (typically less than 4mm) enters the womb and saline solution is injected to dilate it and make it easier to see inside.
‘This can lead to the uterus reacting, leading to intense period-like pains,’ says Dr Michelle Swer, a consultant gynaecologist at St George’s University Hospitals NHS Foundation Trust and London Gynaecology.
HOW TO IMPROVE IT: Taking painkillers such as paracetamol and ibuprofen – or codeine, if a stronger drug is needed – an hour before can help, says Dr Swer.
‘It’s also important that women are informed what the procedure involves and know they do have an option to have this done under a light anaesthetic.’
The NHS says it’s also possible to have intravenous sedation (where you’re not fully unconscious as with a general anaesthetic, but not fully awake either) – or even a general anaesthetic. Not all clinics offer this, so you’d need to be referred to one that does.
Some NHS clinics use mini, flexible hysteroscopes with the ‘vaginoscopic’ technique – this avoids the use of a speculum, instead inserting the camera into the vagina without clamping the cervix.
Dr Byrom adds that GPs can prescribe the sedative diazepam before an examination if a woman is really distressed – so don’t be afraid to ask.
