The Campaign Against Painful Hysteroscopy (CAPH) is urging NHS England to standardize the availability of Penthrox pain relief for outpatient procedures. Recent data suggests a significant gap in care, with many women reporting extreme pain and subsequent medical trauma during routine gynaecological exams.
Why only 31 of 90 responding NHS trusts offer Penthrox
A stark disparity in patient care has emerged from Freedom of Information requests sent to 205 NHS trusts in England. According to the report,only 31 of the 90 trusts that responded routinely provide Penthrox to patients undergoing hysteroscopies. This indicates that a majority of healthcare providers are not utilizing this specific fast-acting painkiller, despite its availability in other medical contexts.
The data further reveals that 48 trusts do not provide the medication at all, though 11 of those are reportedly considering its introduction.. This inconsistency creates a "postcode lottery" for women's health, where the level of pain a patient must endure depends entirely on which NHS trust manages their care.
The psychological scars of Laura Crosby and thousands of other women
The human cost of this gap in care is exemplified by the experience of Laura Crosby, a 38-year-old council worker from Liverpool. As the report describes, Crosby endured "horrific" agony during a routine procedure in November last year, experiencing tremors so severe that nurses had to physically restrain her legs to complete the examination. Such experiences often lead to lasting medical terror and a refusal to seek future care.
CAPH reports that many women describe hysteroscopy pain as exceeding the agony of a ruptured appendix or childbirth. In some cases, the distress is so acute that patients lose consciousness during the procedure, with some later being diagnosed with post-traumatic stress disorder (PTSD). These outcomes suggest that the current reliance on paracetamol or ibuprofen is woefully inadequate for the intensity of the procedure.
The £16 Penthrox device and its 50-year Australian track record
Penthrox is a portable, vape-like delivery system for methoxyflurane, a painkiller that blocks pain signals by activating GABA receptors in the brain. According to the report, the device is highly cost-effective, costing as little as £16 per 3ml unit . Irina Stankeviciute, a clinical hysteroscopy nurse specialist at Chelsea and Westminster NHS Foundation Trust in London, notes that the device is safe and carries minimal side effects, making it an ideal tool for outpatient clinics.
While the device was introduced to the UK in 2016, it has been a staple of Australian medicine for 50 years. Within the UK, Penthrox is already utilized by many of the 14 ambulance trusts for paramedic use and is employed by some NHS trusts for emergency care, proving that the infrastructure for its use already exists within the broader health system.
How RCOG guidelines and the risk of cancer-related deaths collide
The Royal College of Obstetricians and Gynaecologists (RCOG) provides clear guidance that all women undergoing outpatient hysteroscopies should be offered various pain relief options, including local anaesthetics and conscious sedation. However, with approximately 60,000 such procedures performed annually in the UK, many NHS trusts are failing to adhere to these established medical standards.
The consequences of ignoring these guidelines can be fatal. Elaine Falkner, the chair of CAPH, has highlighted cases where women were so psychologically scarred by traumatic hysteroscopies that they avoided essential gynaecological checks for years. In one tragic instance cited by Falkner, a woman died from womb cancer because she refused to return for further examinations after a traumatic experience.
Why NHS England has not mandated Penthrox despite RCOG guidance
Despite the evidence of patient trauma and the existence of RCOG guidelines , it remains unclear why NHS England has not mandated a uniform standard for Penthrox access. The source does not provide a statement from NHS England explaining the barriers to widespread adoption, nor does it clarify if the 48 trusts refusing the medication are doing so due to budgetary constraints or clinical disagreements.
Furthermore, while the report mentions that 11 trusts are "considering" the introduction of the drug, there is no timeline provided for when these patients might see an improvement in care. The lack of a centralized mandate leaves the responsibility to individual trusts, perpetuating the current inequality in pain management.
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