held down by nurses in order to complete an ambulatory hysteroscopy and thus avoid the expense of safely monitored sedation or general anaesthetic. A petition to grant NHS patients full information about the risks of severe outpatient hysteroscopy pain, and the upfront choice of local anaesthetic, sedation, epidural or general anaesthetic was launched in summer 2018. 'End barbaric NHS hysteroscopies with inadequate pain-relief'. It asks the Secretary of State for Health to ensure that: 1. All NHS hysteroscopists have advanced training in pain medicine. 2. All hysteroscopy patients receive full written information before the procedure, listing the risks and benefits and explaining that local anaesthetic may be painful and ineffective against the severe pain of cervical dilation, womb distension and biopsy. 3. All hysteroscopy services are adequately funded so that BEFORE their procedures patients may choose no anaesthesia/ local anaesthesia/ safely monitored conscious sedation/ epidural/ general anaesthetic. 4. The Best Practice Tariff financial incentive, which rewards NHS Trusts who perform a high percentage of hysteroscopies in outpatients without a trained anaesthetist, is abolished. See also Essure procedure for sterilization References External links ACOG education pamphlet Diagnostic obstetrics and gynaecology Endoscopy Female genital procedures