From pain gaslighting to gender biases in women’s accounts of hysteroscopy: A qualitative reflexive thematic analysis

BACKGROUND: Despite being regarded as the gold standard, outpatient hysteroscopy (OPH) is associated with inconsistent outcomes and pain, while the clinical, organisational, and personal determinants shaping patient-centred experience remain poorly characterised. OBJECTIVES: This study aimed to harness the authenticity and richness of naturally occurring online qualitative data to explore the clinical, organisational, and personal factors that shape women's hysteroscopy experiences, offering vital insights for service improvement. DESIGN: An in-depth qualitative investigation of hysteroscopy experiences, as shared by individuals on a publicly accessible online discussion forum. METHODS: Four thousand seven hundred sixty-nine posts across 277 discussion threads published between 2018 and 2024 were collected from Mumsnet.com, representing 1971 forum users discussing their personal hysteroscopy experiences. Posts were analysed using reflexive thematic analysis, informed by a constructivist epistemology and a latent, inductive analytic orientation, to capture both the depth and diversity of online contributions. RESULTS: Five themes captured women's specific hysteroscopy experiences: (1) Contingent Consent, (2) Unacknowledged Vulnerability, (3) Analgesia Roulette, (4) Gynaecological Pain Gaslighting, and (5) Gendered Pain Gap. These themes delineate a hysteroscopy pathway where consent is shaped by limited choices and misinformation, vulnerability is heightened by procedural exposure, pain relief is inconsistently applied, women's suffering is routinely dismissed, and gender biases reinforce unequal standards of care. CONCLUSION: This study identifies clinical blind-spots that contribute to perceptions of systemic neglect in women's gynaecological health care, evidenced by inconsistent pain management, inadequate consent, and gendered biases in OPH. These findings present an opportunity to inform structural reforms that advance equitable, patient-centred gynaecological care and improve clinical accountability.