I am having a hysteroscopy, a new technique for viewing inside the womb. A telescope no bigger than a Biro is inserted into the vagina, through the cervix and into the womb. It contains fibre optics - tiny wires that transmit information to a mini- camcorder attached to the telescope by cable. The pictures are then beamed back on to a giant TV screen. It's like watching Tomorrow's World with your legs in stirrups.
This is through-the-keyhole surgery with no incision necessary: a handy orifice is already provided. And because hysteroscopies provide such a clear picture of the womb, doctors can see anything that shouldn't be there: fibroids, polyps, cancerous growths and adhesions.
Developed in the US, hysteroscopies are not yet widely available in Britain. Yet many doctors believe they are the best technique yet for diagnosing and treating gynaecological problems such as heavy periods, intra-menstrual bleeding and infertility. If more hospitals had one, the hysteroscope would consign dilatation and curettage (D and C) to medical history and greatly reduce the number of hysterectomies.
You don't even need to stay in hospital. I was in the outpatients of the Elizabeth Garrett Anderson Hospital in London in what looked like an ordinary consulting room, except that it had a large TV in the corner and one of those gynaecological couch contraptions with stirrups designed to give easy access to your nether regions. Once the nurse covered my lower half in a starched green shroud, however, the room did take on the feel of an operating theatre and I was fully expecting a jab to render me oblivious to all internal goings-on. No such luck.
"We'll try it without any anaesthetic," announced the surgeon, Mark Broadbent. "Just give me a shout if you feel any discomfort," he added, getting the telescope ready and adjusting the focus of the mini-camcorder somewhere down below.
Usually I'm quite stoical in such situations. After all, I gave birth to a 7lb 6oz baby with no pain relief at all. So a teeny telescope winging its way through my cervix should have been a breeze. But it was not.
"Most women - around 73 per cent - don't need an anaesthetic," Mr Broadbent told me. "The womb is relatively insensitive. It's the cervix [neck of the womb] that feels pain - though there are huge differences between women. With some, you can do fairly drastic things and it feels like a tickle. With others, you only have to look at the cervix and it hurts."
One of the "fairly drastic" things doctors do to the cervix before a hysteroscopy is to clamp it so that the womb doesn't wobble about. Then they put the telescope in.
Muffling yelps of pain, I calculated I must be one of the 27 per cent of women who need an anaesthetic. The surgeon was most obliging and took the telescope out. I watched it vanish from the TV screen.
Many women find the anaesthetic more painful than the procedure itself because the needle goes into the tissue surrounding the cervix. To me, it felt no worse than an injection at the dentist.
But the best antidote to any discomfort is the fascination of seeing one's own insides magnified on a TV screen. For me, this was somewhat tempered by not knowing exactly what I was looking at until Mr Broadbent gave a lengthy lesson on the topography of the reproductive organs.
No matter how well versed one is in textbook diagrams of human biology, it all looks rather different viewed from the inside. So here I was, being shown the most intimate parts of my body by a man talking like a tour guide, pointing out sights such as the Endometrium in Mid-Cycle or the Left Fallopian Tube. It was odd being a foreigner in one's own Fallopians.
I was beginning to enjoy the sightseeing trip, until I remembered the highly visible telescope was there to find something wrong. In my case, it was on the look-out for a rogue polyp or two, a benign growth that can turn nasty if left to its own devices. I'd started to suffer from breakthrough bleeding, which was why polyps were suspected.
What does a polyp look like and how would I know one if it suddenly popped up on the TV screen and waved at me? "They're little tongue-like things lying on the endometrium," the surgeon explained, scouring the lining of my womb for irregularities.
"This here!" he said suddenly, sounding triumphant. "Can you see this bulge here, like a boulder? I suspect that's a fibroid."
How he could make out anything was a mystery to me: the close-up of my womb looked like a lumpy raw lamb chop in a scene from Alien. All I could see were white bubbles floating around, obliterating the view like bars of white Aero. This was the carbon dioxide gas, which has to be squirted into the womb to blow it open before the hysteroscope is inserted.
The whole thing felt more like the drama of a film set than a minor operation. The surgeon really did say "Lights!", though I must admit he stopped short of shouting "Action!"
All very glamorous, but what if the screen reveals a horror? After all, this is live TV; the patient sees everything in gory Technicolor, even if she can't make head nor tail of it.
"It's an advantage," says Mr Broadbent. "Obviously, this is the first time a woman has ever seen the inside of her womb, whether it's normal or abnormal. It's a huge distraction. What's important is that she is actively participating in the procedure. If I see a fibroid or whatever, I can show it to her on the screen and explain that this is the cause of her problems."
With minor problems such as polyps, treatment can be carried out at the same time as diagnosis. Minuscule surgical instruments are fed through a miniature operating channel in the telescope, guided from the TV screen. Large fibroids, however, have to be removed in a separate operation; cancerous growths need a hysterectomy.
Hysteroscopy is fast, efficient, user-friendly and, as we've seen, does not require a general anaesthetic. It is also more accurate than D and C, the "blind" scrape of the womb used for both diagnosis and treatment of gynaecological problems, which has been estimated to miss up to one- third of fibroids and polyps. A hysteroscopy, by contrast, can detect up to 71 per cent of problems. Keyhole surgery could in many cases avoid the far more drastic measure of a hysterectomy, often performed unnecessarily for excessive menstrual bleeding. The only problem is the cost of the equipment - upwards of pounds 60,000 - and the lack of surgeons trained in keyhole surgery techniques.
My benign pathology turned out to be nothing more than one little fibroid. "I'm going to leave it where it is," said Mr Broadbent. "It's not doing any harm." I breathed a sigh of relief.
The lights went off, the telescope came out, and the TV screen went black. A nurse told me to get dressed and go home. The 15-minute sightseeing show was over.
It had been better than any documentary. Maybe next time I'll be able to spot my own Fallopians without the tour guide pointing them out.Reuse content