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CAMPAIGN AGAINST PAINFUL HYSTEROSCOPY
PATIENT SURVEY
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Please help the Campaign Against Painful Hysteroscopy uncover the circumstances, quantify the contributing factors, and evidence the consequences of painful and distressing hysteroscopies.  The survey is anonymous.  Please don't give your name or the hysteroscopist's name but - if you wish - please give the name of the hospital.  The results will be put in the public domain to be used to help improve hysteroscopy services for future patients.  Thank you very much for your time.  Ffi - www.hysteroscopyaction.org.uk  Facebook: Campaign Against Painful Hysteroscopy  Twitter: @hysteroscopyA  (PLEASE NOTE QUESTIONS WITH A RED STAR REQUIRE AN ANSWER).  ONE SUBMISSION ONLY PER PERSON, PLEASE.
1. When you had your hysteroscopy were you: *
2. In which year did you have your hysteroscopy? *
3. Had you given birth vaginally? *
4. Did any of the following apply to you before your hysteroscopy? *
Required
5. Were you aware before your hysteroscopy, that you were able to have the procedure carried out under: *
Required
6. Prior to your hysteroscopy were the following discussed with you? *
Required
7. If you asked for the procedure to take place under GA or IV sedation, did this happen? *
8. If you asked for GA or IV sedation and it didn't occur, please tell us why it didn't.
9. Did you receive a leaflet about the procedure at least one day before your hysteroscopy? *
10.  If you did receive a leaflet, did it:
11. Please tell us if you were feeling anxious about the hysteroscopy prior to the procedure, with 1 being "not at all anxious" and 10 being "extremely anxious". *
1 Not at all
2
3
4
5
6
7
8
9
10 extremely
How anxious were you?
12. Did you take painkillers before the appointment for your hysteroscopy? *
13.  If you did take painkillers, what did you take?
14.  Which procedure(s) did you have? *
Required
15.  During the procedure were any of the following used? *
Required
16.  Were you happy with the way the nurse at your side looked after you? *
17. If you've said you weren't happy with the way the nurse looked after you, please explain.
18. If you experienced pain/distress, did the hysteroscopist immediately offer to reschedule with either general anaesthetic (GA), intravenous (IV) sedation, epidural? *
19.  If you experienced pain, did you agree to continue with the painful experience? *
20.  If you've answered yes to the previous question, why was that?
21.  On a scale of 1-10 with 1 being no pain and 10 being maximum pain, please indicate level of pain you experienced at the following stages, if applicable. *
No pain 1
2
3
4
5
6
7
8
9
Maximum pain 10
N/A
Insertion of speculum
Local anaesthetic injection
Stretching open the cervix
Pressure of water
Inserting the camera into the womb
Removal of polyp/small fibroid
Taking pipelle biopsy
22.  Were you offered Entonox (gas and air) to relieve pain during the procedure? *
23.  Were you well cared for in a recovery unit? *
24.  Were you given a post-op advice leaflet? *
25.  Once home, for how long were you distressed/tearful/shaken? *
26.  If you answered "longer" to the previous question, please tell us more:
27.  If you had an hysteroscopy in future which would you prefer? *
Required
28.  If you experienced pain during an outpatient hysteroscopy, how has this affected you long term? *
Required
29.  Were you asked to provide a pain score at anytime during or after your procedure? *
Required
30. Regarding your consent: *
Required
31.  Here's how I think NHS hysteroscopy could be improved:
32.  Which hospital did you attend for your outpatient hysteroscopy? (optional)
33. Is there anything else you'd like to tell us about your procedure?
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