Thousands of real-world patient accounts expose how inconsistent care, dismissed pain, and unequal treatment continue to shape women’s experiences of a common but often distressing procedure.
Study: From pain gaslighting to gender biases in women’s accounts of hysteroscopy: A qualitative reflexive thematic analysis. Image credit: Iryna Inshyna/Shutterstock.com
A new Women’s Health study analyzed unprompted, real-life conversations shared on Mumsnet to explore the clinical, organisational, and personal factors that shape women’s hysteroscopy experiences.
The need to improve the delivery of hysteroscopy services
Hysteroscopy is a common medical procedure whereby doctors examine the uterus. It is often the first step while assessing symptoms such as irregular or heavy periods. In the United Kingdom, hysteroscopy is predominantly performed in the outpatient setting, referred to as outpatient hysteroscopy (OPH). In England, about 71,000 procedures are undertaken per year.
To visualize the uterine cavity, hysteroscopy is considered the gold standard; however, there is significant heterogeneity in success rates (77 % to 97.2 %). Failure to complete OPH is mainly linked to procedural pain, with more than 85 % of patients experiencing pain and 15 %–34.8 % of women reporting severe pain. Some reports offer insights into pain and satisfaction during and after the procedure, but they may fail to provide a holistic view of the procedure's true impact.
Research on the lived experience of hysteroscopy care is scarce, which limits the ability to translate patient experience into clinical improvement. The Royal College of Obstetricians and Gynecologists (RCOG) recommends qualitative research to assimilate patient perspectives into clinical care. A rich source of qualitative data is online discussion forums that women often use to share experiences and seek advice. These discussion forums could offer novel insights that might help improve the quality of service.
Assessing the Mumsnet dataset to identify key patterns and insights
Mumsnet is a UK-based parenting site with about 700,000 posts per month and 33.1 million monthly visits. About 52.6 % of users identify as female, and accounts shared on Mumsnet encompass views from across the United Kingdom. The posts and replies are unprompted and are in no way researcher-led.
Data were extracted between 4 March 2018 and 31 December 2024 inclusive, and all posts relating to issues other than hysteroscopy were excluded. Across 1971 users, 4769 posts were scraped, and after exclusion, 4644 posts from 261 threads remained. Forums often contain multiple perspectives on a topic. The analysis conducted was reflexive and thematic, capturing the depth and diversity of conversations and focusing on the coherence of the analysis.
To represent the specific experiences of women on the hysteroscopy trajectory, five themes were constructed: contingent consent, unacknowledged vulnerability, analgesia roulette, gynaecological pain gaslighting, and gendered pain gap.
Clinical blind spots influence perceptions of neglect in OPH
Regarding contingent consent, patients received inadequate information, which prevented them from making informed choices. This often led to feelings of hurt and disappointment. Consent was often given due to fear of symptom progression and necessity rather than by genuine preference, as OPH was presented as the only timely intervention strategy. Withdrawal of consent was difficult due to explicit pressure from clinicians, fear of pain worsening, or inaccurate information.
The intimate nature of the procedure made women feel physically and emotionally vulnerable, and the comments from the users highlighted a power imbalance between the clinician and the patient. Comparisons were made with sexual violence, and patients with a prior history of sexual abuse reported heightened feelings of vulnerability. The adverse effects were long-lasting and prevented help-seeking behavior, which in turn made patients more clinically vulnerable overall.
Inconsistencies were reported in the administration of general anesthetics (GA) and over-the-counter (OTC) pain medications. Significant heterogeneity was observed across trusts and hospitals in pain management. This inconsistency fostered a sense of injustice as it made patients believe that pain relief options were down to luck. Forum users also expressed concern at not being given more options for pain management, while acknowledging the difficulty of standardizing pain relief.
Forum users also alluded to being blamed by healthcare professionals and a systematic minimisation and invalidation (“gaslighting”) of their concerns. The legitimacy of women’s pain experiences was questioned, and in some cases, medical records were reported to contradict patients’ lived experiences at the very beginning of the hysteroscopy pathway. At the waiting stage, hysteroscopy was positioned as “tolerable for most”, which felt inauthentic to forum users.
The data illustrated perceived gender biases in medical care, and historic assumptions about female pain were deemed archaic. A fundamental disconnect in the perception of pain was noted between male and female patients. Forum users also hinted at the use of distraction techniques to manage pain instead of effective pain relief. Other concerns centered around infantilizing women, a sense of distrust, and a deep sense of discrimination. Normalizing female pain creates unequal standards for pain management, leading to a lack of trust in the healthcare system.
Conclusions
The current study used qualitative data to detect clinical blind-spots in OPH centered around five themes, namely, contingent consent, unacknowledged vulnerability, analgesia roulette, gynaecological pain gaslighting, and gendered pain gap. These insights should help devise reforms to ensure more equitable, advanced, patient-centric, and accountable treatment strategies for women.
However, the authors note that online accounts may overrepresent negative experiences, and hysteroscopy experiences can vary widely, with many women tolerating the procedure in some settings. The findings should therefore be interpreted as contextualised accounts rather than representative of all patient experiences or indicative of prevalence, highlighting broader systemic and organisational drivers of care variability rather than uniformly poor care.
Download your PDF copy by clicking here.
Parasites trigger a gut-to-brain signal that cuts food intake during infection