Ask most women what they were told before a coil fitting or a hysteroscopy, and the answer is often the same: “you might feel some discomfort.” Ask what actually happened, and the picture looks different.

During coil fittings, nearly 1 in 2 (48.7%) reported moderate or severe pain, and almost 1 in 5 reported severe pain (1). For hysteroscopy over 9 in 10 (92.2%) report pain of which 17.8% report severe pain (2). There is also compelling evidence that clinicians systematically underestimate gynaecological pain (3). That gap, between the phrase used to prepare patients and the pain many of them go on to describe, is where my research sits. 

Working with colleagues, I analysed thousands of posts from women describing their hysteroscopy experiences on Mumsnet (4), one of the few places many felt they could be fully honest about what happened. What came through wasn’t a story about a dangerous procedure. It was a story about inconsistency: some women received general anaesthetic, others were offered paracetamol and told to see how they got on, a gap one participant described as a lottery rather than a plan. Consent, in many accounts, was shaped by being told the procedure would feel like a cervical screening (smear) test, a comparison several women later felt was actively misleading. And when pain did happen, it wasn’t always believed. A second study (5), looking at what women actually go looking for once they’re referred, found the same pattern from a different angle: clear, practical questions about pain and recovery that clinical information routinely left unanswered, questions that pushed women to build their own peer networks online just to get a straight answer. 

I want to be precise about what this is and isn’t saying. Outpatient hysteroscopy is clinically safe and saves lives. The procedure isn’t the problem. The problem is that the move to outpatient care happened faster than the pain relief offering did, and it happened without fully reckoning with something pain research has known for decades: pain isn’t a fixed physical signal, it’s shaped by anxiety, past experience, how safe someone feels in the room, and how much control they have over what’s happening to them. Treat pain as purely mechanical and unstandardised pain relief looks like bad luck. Treat it as biopsychosocial, meaning genuinely shaped by mind and body and circumstance together, and it starts looking like the actual, fixable problem. 

What gives me hope is a shift underway in how research and clinical practice treat that gap. Patient and public involvement, or PPI, is moving from a tick-box exercise to something research funders now expect to see built into a study from the start. That matters because it changes what gets studied and measured in the first place. Pain has historically been treated as too subjective to prioritise. PPI is part of why that’s changing. 

You can see it in clinical practice too. Some trusts are piloting conscious sedation as a pain relief option for outpatient hysteroscopy, and their experience is starting to influence how others think about offering it. Nationally, the Women’s Health Strategy was notable for naming medical misogyny explicitly, rather than treating the pain gap as an individual clinical judgement call. The British Society for Gynaecological Endoscopy (BSGE) has also updated its position on hysteroscopy pain, which matters because professional bodies, not just patients, are now saying the current standard isn’t good enough.  

None of this means the problem is solved, and whilst I would recommend any women referred for gynaecological procedures to search for the best practice guidelines by the Royal College of Obstetrics and Gynaecologists as well as the BSGE, I want to be careful about where I land this. It’s become common to frame the fix as women being empowered to speak up, to ask questions, to say stop if a procedure hurts. That’s true, and it matters. But it also quietly shifts the responsibility onto the person already in the most vulnerable position in the room. Good practice shouldn’t depend on a patient’s confidence to interrupt her own doctor. It should look like clinicians checking in as a matter of routine, not waiting to be asked. 

That, more than any single new guideline, is what the research is actually pointing toward: that a better analgesic offering needs to be coupled with a different starting assumption about the quality of clinical interactions women deserve. When we return to kindness in care, the trust will follow.  

References: 

1) Camões-Costa V, Kwok C, Pascoe M, White S, Mazza D. Factors Associated With Pain Related to Insertion of a Contraceptive Intrauterine Device: Findings of a National Survey. Aust N Z J Obstet Gynaecol. 2026 Apr;66(2):e70125. doi: 10.1111/ajo.70125. Erratum in: Aust N Z J Obstet Gynaecol. 2026 Aug;66(4):e70162. doi: 10.1111/ajo.70162. PMID: 41969241; PMCID: PMC13071863. 

2) Harrison R, Kuteesa W, Kapila A, Little M, Gandhi W, Ravindran D, van Reekum CM, Salomons TV. Pain-free day surgery? Evaluating pain and pain assessment during hysteroscopy. Br J Anaesth. 2020 Dec;125(6):e468-e470. doi: 10.1016/j.bja.2020.08.015. Epub 2020 Sep 15. PMID: 32943190. 

3) Maguire K, Morrell K, Westhoff C, Davis A. Accuracy of providers’ assessment of pain during intrauterine device insertion. Contraception. 2014 Jan;89(1):22-4. doi: 10.1016/j.contraception.2013.09.008. Epub 2013 Sep 21. PMID: 24134898. 

4) Cromme SK, Harrison R, Finlay KA. From pain gaslighting to gender biases in women’s accounts of hysteroscopy: A qualitative reflexive thematic analysis. Women’s Health. 2026;22. doi: 10.1177/17455057261440884 

5) Cromme SK, Harrison R, Finlay KA. “I would much rather hear the truth so I can be prepared”: Virtual peer support, health access, and information-seeking after hysteroscopy referral. Women’s Health. 2026;22. doi: 10.1177/17455057261484349