Gynaecological Violence Is More Common Than You Think

When Kate, 23, first noticed that her period had become irregular, she didn’t know she was about to face months of excruciating pain.

In December 2020, an ultrasound showed a mass in one of her ovaries. But she struggled to book a follow-up appointment, as the doctor she saw didn’t take medical notes. Two months later, she began experiencing strong abdominal pain. After spending several feverish nights sweating through her clothes, Kate went to A&E in London. 

She was told that she might have intestinal COVID symptoms. A surgeon asked her to jump to see if she was well enough to be discharged and sent her home. Two days later, her COVID test came back negative. By the time Kate was admitted to the gynaecological ward about two weeks later, doctors found abscesses in her uterus. She was relieved to be finally taken seriously, but the feeling would vanish in the following weeks.

Doctors first removed her IUD to analyse if any bacteria attached to it could have caused the problem. She wasn’t offered anaesthetic, and was only given gas and air after the pain of removal reduced her to tears and screaming. Then, after undergoing surgery to remove the abscesses, she was told that she was showing signs of improvement and that she could go home. 

A week later, the pain made her return to hospital. Doctors revealed that the remaining abscess was the source of the trouble. Kate, who is speaking anonymously to protect her privacy, says that she was led to believe that the abscess was fully removed.

She finally decided to get treatment in Italy, where her family lives. It turned out that the leftover abscess had grown into her right fallopian tube and spread close to her appendix. Surgeons in Italy had to remove both.

“The main issue was that when I was telling them that something was seriously wrong, they weren't taking me seriously,” she says of her hospital experience. “You have to be extremely firm, but when you're sick you can't be that firm.”

Gynaecological violence, according to the Parliamentary Assembly of the Council of Europe, is violence suffered during gynaecological consultations. One may be a victim of sexism, humiliation and physical violence during examinations. The report defines carrying out painful interventions without anaesthetic – as Kate experienced with her IUD removal – as a non-consensual act.

In the year 2020/2021, more than half of all complaints received by NHS Trusts and Clinical Commissioning Groups (CCGs) in England regarding gynaecology and obstetrics were about the neglected psychological and physical well-being of patients. 

Eighty-four NHS trusts and CCGs responded to Freedom of Information (FOI) requests filed by VICE, revealing that 51 percent of all complaints were recorded under the subject areas of Patient Care and Clinical Treatment. These two categories included issues such as inadequate pain management, misdiagnosis, failure to follow up, inadequate support and procedures carried out in a traumatic way.

Complaints under the Communications subject area – which includes receiving incorrect or no information – accounted for almost 19 percent of the total. Around 16 percent of the complaints were recorded in the Values and Behaviour, Privacy, Dignity and Wellbeing and Consent categories with issues raised about the attitude of staff, breach of confidentiality, lack of compassion and consent. 

A NHS spokesperson told VICE: “The Royal College of Obstetricians and Gynaecologists provides detailed clinical guidance on these procedures which clinicians should be following.

“All patients should be treated with care and kindness, respect and dignity. Patient safety and patient experience must be at the core of any NHS service.”

The Campaign Against Painful Hysteroscopy are some of the people fighting against this kind of malpractice. The group was set up by patients who had a traumatic experience with this inspection of the uterus, which can be very painful for some. They raise awareness about the lack of pain relief options and the lack of information available to those undergoing the procedure. CAPH co-founder Katharine Tylko says that some people in the group with serious health issues are still hesitant to go back for check-ups, to avoid experiencing more pain.  

Member Grace, 63, who has changed her name for privacy reasons, is one of those patients. She joined the group last September after an agonising hysteroscopy performed without an offer of pain relief and is still wary of returning to the clinic. 

She says that she was not asked to rate the pain she felt on a scale from zero to ten, just like the vast majority of respondents to CAPH’s dissatisfaction survey. That left her with little evidence when she complained to the health board, as the medical staff could neither recall her procedure nor that she suffered extreme pain. 

It is not standard practice to ask patients for a pain score, but Grace thinks that if it was, it would provide the medical profession with evidence that the procedure is painful. “As a result of my complaint, the consultant who conducted my procedure says that he will, in future, record pain scores for all his hysteroscopy patients,” she tells VICE. “I hope he does.”

Disregarding a patient’s pain can be incredibly damaging. Shirin Ermis, a 23-year-old German student living in the UK, was misdiagnosed twice in 2019. The first time was when she arrived in pain at A&E in Durham. Shirin knew she had a cyst in one of her ovaries and informed the medical staff about it, but it was ruled out as the cause.

“I got really frustrated and wanted to push my way into being treated because I felt they were just not taking it seriously enough,” she says. An ultrasound showed that the cyst was there, but doctors ignored it and made her spend the night in the ward to check her appendix. Nothing showed up on tests, and Shirin was discharged when she felt better in the morning.

Back in Germany for the holidays, the pain flared up again and she had to get emergency surgery to take the cyst out. A second flare-up happened during the summer in Oxford. At this point, she had an endometriosis diagnosis from her German doctor, but the ambulance paramedics only gave her painkillers. 

Endometriosis may lead to organ damage if left untreated, and Shirin had to get another surgery in Germany that autumn. She has recovered but says that now she tries to be more assertive when walking into medical practices.

Gynaecological violence doesn’t just happen to women – it can also affect intersex and transgender people. In 2021, Louie Stafford, a 36-year-old founder of an LGBTQ+ non-profit, suffered a painful smear test at a GP surgery in South Leeds with a senior nurse practitioner. 

Louie is a trans man and, “because I'm quite a big guy, she presumed just looking at me that she knew what size speculum I needed,” he tells VICE. “And she used one that was far too big… Despite me actually crying out in pain and being like ‘stop doing that’.”

“Then she went down to the smaller size, and that was fine. But it was pain like I've never felt before, and I ended up getting a tear inside me as a result of that. It was really traumatic.” 

Taking testosterone can cause vaginal atrophy, which makes the vagina’s tissues thinner and more sensitive. This would require extra care when treating a patient – which didn’t happen in Louie’s situation. He believes that the awkwardness that practitioners may feel when treating trans people might prevent them from communicating with them and mitigating their concerns. 

Dr Laura Jarvis, a specialist doctor in sexual and reproductive health at the Institute of Psychosexual Medicine, says that lack of communication and information often leads to a more uncomfortable gynaecological appointment. 

“If you feel it’s really painful, we must just stop,” she says. “Some people don't feel in control, maybe they don't have the right information before they go into the procedure.”

When told about the results of the analysis VICE did on NHS complaints, Jarvis was not surprised. “A big majority of medical complaints are about communication… It's really important to create an atmosphere in the room where the patient feels that they're being listened to and there's good communication.

“Certainly, making people feel ashamed for feeling pain is very bad, isn't it?”