Most women, at some point in their lives, will hear the words “This might hurt”. Not from an aggressor, but from their doctor or nurse. Because too many intimate procedures in women’s healthcare involve pain. Women are expected to tolerate that pain.
And this isn’t the fault of individual doctors or nurses. It’s because not enough focus or resources have been given to challenging that expectation. The procedures we have – be they smear tests, coil fittings, or hysteroscopies – are painful and uncomfortable. All too often, as a result, women put off getting the help they need because they are worried about that pain.
Difficult to talk about
This isn’t the only way in which women are expected to put up with pain. The stubbornly grim statistics for gynaecological cancers can partly be put down to the fact that, when women talk to their doctors about the pain they’re feeling in those parts of the body that are more awkward to talk about, they are not believed.
Target Ovarian Cancer research has found that one-quarter of women in Wales report visiting their GP three or more times before being referred for tests. One-third report waiting more than three months from their first appointment with the GP to receiving a diagnosis.
Doctors either don’t have the training to recognise symptoms of some cancers, or not enough research has been done into finding more accurate ways of interpreting those indistinct types of pain. And then, there are those debilitating conditions affecting women that we still don’t know enough about, because of a lack of research or understanding.
Endometriosis is a condition that affects roughly one in 10 women, and occurs when the tissue inside the uterus begins to grow outside it, leading to chronic pain. As the British Pregnancy Advisory Service points out, despite the prevalence of endometriosis, it remains underdiagnosed and too often misunderstood.
With this condition and so many others, women are too often either gaslit, told not to worry, to wait to see if things get worse, or they’re psychologised, asked whether they suffer with anxiety. And all of that makes women, again, less likely to seek out help, because their pain is, if not trivialised, then minimised, played down. They are told not to trust their own gut instincts that something is wrong.
Not trusted, not believed
How many women’s lives are lost or made miserable through pain because they fall into a gap in our healthcare system where their words aren’t trusted, their instincts dismissed. Where women are told that they don’t understand their own bodies and how they work? In procedures, the pain that is inflicted on women is accepted as normal or downplayed, and the pain women speak about or seek help for is also lessened.
Why should we have to put up with so much pain? Why is that normal?
There was a letter in a mainstream newspaper a few years ago in which a woman spoke about the pain she endured when having a hysteroscopy. That is when a camera is inserted into the vagina and cervix, into the uterus. No anaesthetic or sedation was offered to her, but some years later when that same woman had to have a colonoscopy for another condition, it was done under sedation. As she said in her letter, “There was no question of doing it without”.
With more regular procedures too, like smear tests, a certain amount of pain is just expected as normal. We have had debates in this Senedd in recent years focused on the alarmingly low take-up rates of smear tests. The awkwardness and uncomfortableness of the procedure will surely play its part in driving down those figures.
I’m not a medical professional, and what’s more, I have the utmost respect for those who dedicate their professional lives to helping others. I’m sure the vast majority of doctors, nurses, and healthcare professionals find this situation deeply concerning too.
Deadly systemic issues
Again, this is not about individuals. It’s about the systemic lack of research, resources, and thoughts given over to lessening the need for pain in gynaecological procedures. The absence of a dedicated women and girls’ health plan in Wales is unquestionably part of the problem.
Other governments, like the Scottish Government, the Norwegian Government, the Swedish Government, and the Canadian Government, have published women and girls’ health plans. The plans have allowed those countries to focus more on ensuring that women’s voices are central to their healthcare. Wales is lagging behind.
Our first female First Minister has laudably spoken about tackling this issue at long last, but it should not have taken so long. Again, how many women have been lost or have had to endure unacceptable levels of pain because of this delay? It is a delay that has surely cost lives.
Figures sent to me by Claire’s Campaign highlight the magnitude of the problem. The target for women starting their gynaecological cancer treatment within 62 days is 75%. Yet in July of this year, only 26.9% of women in the Aneurin Bevan Health Board area managed this. That is only seven in every 26 patients. Between 20 and 30 patients receive a gynaecological cancer diagnosis every month, but the health board only manages to get seven or eight women through to treatment within the target.
A proper women’s health plan
This is only one reason why I’d agree with Claire’s Campaign that the women’s health plan must include a specific focus on gynaecological cancers. I’d be grateful to know whether this will happen and whether the plan will also look at clinical culture and some of the hindrances that are costing women’s lives.
The women’s health plan must learn from the experiences of patients, gynaecologists, midwives, and women’s health groups. That is why my motion would ensure establishing a legal requirement for healthcare providers to collect feedback from female patients about their experiences, especially gynaecological appointments, midwifery and postnatal services, perinatal health, and menopause.
Too many women are left feeling isolated, violated, and in pain after these appointments. It shouldn’t be normal. We have an obligation to ensure that it isn’t.
There are so many levers within the Welsh Government’s control that they can take to address this endemic problem. The Welsh Government has the ability to influence the curriculums of healthcare courses that are delivered and funded within Wales to provide additional training in women’s healthcare.
It can influence national regulatory bodies like the General Medical Council and the Royal College of General Practitioners to tailor aspects of its training standards, or to implement initiatives to better address women’s health.
No more normalising avoidable pain
The Welsh Government can issue guidance as well, to NHS institutions within Wales. And I’d want that guidance to focus in particular on addressing gender bias in pain management. That guidance must surely be coupled with the legal requirement for NHS institutions in Wales to collect feedback from female patients, as I’ve already mentioned, to identify areas for improvement in addressing the physical and psychological pain that is accepted as normal in women’s healthcare.
The Welsh Government should support research into women’s health issues, particularly into pain perception and gynaecological cancers. We should be learning from other parts of the world that have found innovative ways of tackling low and late diagnosis rates, like introducing mail-in testing kits for cervical cancer. That happens in Denmark.
I know that some other Members will also be focusing remarks on how we must improve treatment for women going through the menopause and women suffering with postnatal depression. The pain suffered by women in their healthcare can be physical; it can also be psychological. And it is unacceptable. It is costing lives.
I hope that if this motion passes it will result in improved guidance, in changes in procedures and better training for health professionals. Women make up half our population. Their suffering should not be treated as normal.
