East Suffolk and North Essex NHS Foundation Trust

3. Miss F complains about the care she received at the Trust during visits to the Trust’s hospital on 1, 7, and 28 March and 2 May 2025. Specifically, she complains staff did not diagnose the cause or provide her treatment for the pelvic pain, urinary and gynaecological infections she presented with.

4. As a result, Miss F says the lack of treatment has left her in avoidable pain throughout the period she complains about, which has continued since the events. She explains this means she has had to stop working. She has found all this distressing, and it has triggered her underlying depression and suicidal ideations.

5. She adds, because of the Trust’s lack of diagnosis and treatment, she incurred private medical costs to seek private treatment to manage her symptoms.

6. By bringing her complaint to us, Miss F wants the Trust to apologise and pay her a financial remedy to recognise the impact of the events. She also wants the Trust to reimburse her private medical costs.

7. This background is intended to place the key events related to this complaint in context, not to provide a detailed chronological account of everything that happened.

8. At the end of January 2025, Miss F began experiencing vaginal and pelvic pain, along with fever and general ill health.

9. Over the following weeks, her symptoms exacerbated, causing her cervical tenderness, severe pain, fever, and recurrent infections. Different NHS and private clinicians did swab tests to check for pelvic inflammatory disease (PID). PID is an infection that affects the womb, fallopian tubes and ovaries. Based on Miss F’s negative results, they did not consider she had PID.

10. A&E attendances on 1, 7, 28 March and 2 May 2025 made Miss F concerned the Trust did not investigate her symptoms accurately or provide effective treatment for her recurring pain and vaginal and urological infections.

11. During her admission to the Trust’s emergency gynaecology ward on 7 March 2025, a doctor commenced intravenous antibiotics, citing clinical suspicion of PID despite negative swabs.

12. On 8 March 2025, a senior consultant gynaecologist did not reach a PID diagnosis, suggesting the cause for her recurring pelvic pain might be endometriosis instead. Endometriosis is a condition when cells similar to the ones in the lining of the womb are found elsewhere in the body. The consultant discharged her, noting Miss F had been diagnosed with endometriosis three years earlier.

13. By 27 March 2025, Miss F’s condition had deteriorated, causing difficulty walking and severe lower abdominal pain. Her private gynaecologist referred her to the NHS for an emergency CT scan to rule out PID or appendicitis.

14. When she presented to the Trust, the hospital did not see a clinical reason for Miss F to have a scan as her blood test results were normal.

15. A follow-up letter from her private gynaecologist on 2 April 2025 highlighted a heavy candida glabrata infection (a type of yeast infection) resistant to antibiotics. The private gynaecologist requested an urgent private CT scan, while also recommending a consultation with a GUM clinic (sexual health clinic) to address recurring vaginal dysbiosis (an imbalance between good and bad bacteria in the vagina, leading to increased risks of infections).

16. On 2 May 2025, the Trust admitted Miss F again when she presented to its A&E department. During this admission, three gynaecologists could not reach a conclusive diagnosis.

17. On 6 May 2026 the Trust discharged Miss F to the care of her GP to arrange a referral to the chronic pain team and to have an outpatient MRI (magnetic resonance imaging – a type of scan). The Trust provided her with painkillers and safety netting advice, should problems reoccur.

21. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen. We have done this and have not found any indications that something has gone wrong. We will explain the reasons for our decision in more detail below.

Lack of diagnosis or treatment for pelvic pain during A&E attendance on 1 March 2025

22. Miss F complains the Trust did not investigate her pelvic pain symptoms appropriately when she attended its Emergency Department (ED) on 1 March 2025. Miss F said she had symptoms of PID but the Trust sent her away without antibiotics or guidance.

23. The Trust’s complaint response did not provide a specific comment on the care provided on 1 March 2025. The Trust said overall it was satisfied that staff had followed the correct national guidance and local policies in treating Miss F.

24. Having considered the available evidence, we are satisfied the Trust acted within relevant guidance in investigating Miss F’s symptoms.

25. NICE PID guidelines say PID is a general term for infection of the upper genital tract, which typically affects sexually active women under 25. The guidelines say the diagnosis of PID should be made on the basis of clinical features (symptoms, contraception, sexual history, and the outcome of examinations and investigations). The guidelines say clinicians should prescribe antibiotics as soon as a working diagnosis of PID is made.

26. Miss F’s ED observations and clinical records on this day demonstrate a comprehensive assessment in line with NICE PID guidelines. The ED team asked about her symptoms, contraception, and sexual history. They also carried out an internal examination and took blood tests and vaginal swabs. Our EM adviser confirmed the Trust took all necessary and appropriate steps to investigate the underlying cause of her acute pelvic pain presentation and effectively ruled out a serious problem requiring immediate treatment.

27. The collection of a vaginal swab was clinically appropriate to investigate suspected bacterial vaginosis (BV) and to exclude other common causes of acute pelvic pain. The Trust documented Miss F’s GP and/or urology would need to follow up on the result of the swab.

28. There is evidence confirming ED clinical staff examined Miss F thoroughly and went to great lengths to assess the root cause of her acute pain within emergency medicine settings. Having done so, all Miss F’s results showed no evidence of acute disease. The absence of acute findings in the ED investigations supports the Trust’s diagnosis of chronic pelvic pain.

29. As the Trust’s investigations revealed no abnormality or signs of PID or other infection, it was in line with NICE PID guidelines for the Trust to not prescribe antibiotics.

30. Our EM adviser explained emergency care focuses on the diagnosis and management of acute presentations. Chronic pelvic pain is a long term condition which requires comprehensive investigation and management plans, typically coordinated through primary care and community-based specialist services.

31. Taking into account guidance set out above, Miss F’s medical records, and the clinical views of our EM adviser, we consider the Trust’s ED clinical staff examined Miss F’s pelvic pain in full on 1-2 March 2025 before discharging her to the care of her GP. We recognise Miss F was in a lot of pain, but we have seen no evidence she had signs of a problem which needed emergency treatment in ED.

Lack of appropriate investigations and treatment for pelvic pain during emergency gynaecology admission on 7-9 March 2025

32. Miss F complains when she attended the Trust’s emergency gynaecology department on 7 March 2025, the Trust did not confirm the hypothesis of PID. She says this was because her C-reactive protein (CRP) test results were not very high and her swabs were negative for gonorrhoea and chlamydia.

33. She also says the gynaecological consultant advised her problems were caused by endometriosis without carrying out investigations or considering her symptom history. She is dissatisfied the Trust discharged her the following day.

34. We note Miss F presented the Trust with a private GP referral letter, stating ‘swabs pending’ (a diagnostic test to investigate the presence of infection in the vagina) and indicating Miss F had already been on a course of antibiotics to treat possible PID.

35. The Trust’s response regarding this admission indicates it provided her with intravenous gentamicin and clarithromycin (two antibiotics administered by an injection into her vein) and she then self-discharged.

36. We have considered the available evidence and we confirm the Trust acted within relevant guidance in investigating and treating Miss F’s symptoms.

37. Miss F’s emergency gynaecology observations on 7 March 2025 show her clinical assessment was stable. On examination her abdomen was soft, despite the presence of tension and tenderness when pressing the area over the lower abdomen and right iliac fossa (lower abdomen right side).

38. We also note the Trust was aware she had a background history of endometriosis and previous laparoscopy (a type of keyhole surgery used to diagnose and treat endometriosis) in 2022. The Trust noted Miss F had not been sexually active since 2022. The Trust also were aware she had recently completed a course of antibiotics whilst also taking prophylactic antibiotics due to recurrent urinary tract infection (UTI).

39. Upon admission, the Trust ran blood tests but the results came back normal. The Trust also carried out an internal ultrasound scan which did not show any abnormality. Miss F also had vaginal swabs and these were normal.

40. Our gynaecologist adviser explained there is no specific guidance on the assessment and management of a woman experiencing acute pelvic pain. While PID could be a significant possible diagnosis, Miss F’s clinical notes document such a diagnosis would be highly unlikely in a woman who had not been sexually active for three years. This is because acute PID (in almost every case) is a consequence of a sexually transmitted bacterial infection.

41. Finally, our gynaecologist also explained another common cause of severe pelvic pain could be endometriosis, a condition where cells similar to those in the womb lining grow elsewhere in the body (the pain from which can often be atypical in nature), and indeed it is documented Miss F received an endometriosis diagnosis in 2022.

42. It is documented that Miss F wanted to leave hospital on 9 March. The Trust discharged her and referred her for outpatient follow up in the gynaecology clinic to consider her symptoms further. The Trust noted Miss F’s pain may be due to a re-presentation of endometriosis.

43. Because of the reasons set out above, Miss F’s hospital records which show normal test results, and the clinical views of our gynaecologist adviser, we consider the Trust examined Miss F’s pelvic pain symptoms to a satisfactory level on 7-9 March 2025 before discharging her for further outpatient investigations.

44. We do acknowledge Miss F was continuing to be in pain and this was frustrating and utterly discomforting. We have not seen any evidence the Trust needed to do anything else for her as an inpatient during this brief admission.

Lack of appropriate investigations and treatment for pelvic pain during Emergency Gynaecology admission on 27 - 28 March 2025

45. Miss F complains she attended the Trust’s emergency gynaecology a third time on 27 March 2025 with a similar presentation of severe worsening pelvic pain around the lower abdomen and right iliac fossa. Miss F was struggling to move because of the pain.

46. This time, she supported her request for help by giving the hospital staff another private gynaecologist’s letter showing swab results positive for enterococcus (a type of bacteria) and severe candida glabrata (a type of yeast) infections. However, she says hospital staff attributed her symptoms solely to candida and discharged her again the following day.

47. From available clinical records, we note on this admission Miss F’s blood tests were normal, and her observations were stable. The Trust also took repeat tests, including a high vaginal swab and urine dipstick test to check for new or ongoing infections. No chlamydia or gonorrhoea were detected.

48. The Trust’s response does not explicitly mention Miss F’s admission on this specific date, although both its response and the discharge summary state clinical staff discussed with her a possible diagnosis of endometriosis for her recurrent pain, as was suspected on her previous admission.

49. Miss F’s clinical records also demonstrate that, upon discharge from hospital, clinical staff referred her to outpatient gynaecology care for deeper investigations and ongoing treatment.

50. Our gynaecologist adviser explained the plan the Trust made for Miss F was appropriate. Her observations and blood tests were normal, and her tests returned no signs of gynaecological infections. Therefore, referring her to the outpatient gynaecology clinic, including a probable plan for laparoscopy, is in line with what NICE endometriosis guidelines recommend to check for and rule out endometriosis as a cause of her chronic pain.

51. We recognise it was distressing and disappointing for Miss F to be discharged for outpatient investigations again when she had long-term and persistent pain. We consider the Trust’s actions to be in line with guidance.

Lack of appropriate investigations, diagnosis, and treatment for pelvic pain during admission on 2 - 6 May 2025

52. Miss F presented to the Trust’s ED on 2 May 2025 with the same problem of persistent pelvic pain. The Trust admitted her again to its gynaecology ward. She is very unhappy about this hospital stay because three different gynaecologist consultants gave her three different clinical opinions.

53. She says the first gynaecologist considered she had endometriosis, dismissed the connection between enterococcus infections and PID, and offered her the birth control pill as a way to manage her pain.

54. She says the second gynaecologist considered she did not have endometriosis. She says this gynaecologist was unfamiliar with gynaecological conditions Miss F raised to them having spoken to her private gynaecologist before attending the hospital (aerobic vaginitis, cytolytic vaginosis – both vaginal infections). She says the second doctor suggested she might want to consider opting for private care if financially viable.

55. Finally, Miss F says the third gynaecologist who examined her did not provide any diagnosis.

56. Miss F also complained her discharge letter on this occasion mentions a referral for an MRI scan, which she still did not have an appointment for at the time of raising her concerns with us in September 2025.

57. We can see the Trust responded to Miss F’s concerns about this specific admission. In its outcome letter, it states the gynaecologist consultant on duty observed she had intolerable vaginal pain, noted she had been sexually inactive over the past three years and reviewed Miss F’s medical history.

58. The Trust then confirms that, based on all above observations, the gynaecologist considered a new onset of pelvic infection very unlikely, as Miss F had already just completed a course of antibiotics before attending emergency gynaecology on 8 March 2025, two months earlier.

59. The gynaecologist also did not consider it appropriate to give her another course of antibiotics as Miss F had not undergone any major pelvic surgery recently or had any intrauterine (inside the uterus) devices in place, which are common factors for potential pelvic infections. The Trust highlights giving unnecessary antibiotics under these circumstances can cause more harm than benefit, increase the risk of thrush and buildup of antibiotic resistance in the body.

60. We note the Trust’s letter also goes on to explain the gynaecology team discussed possible explanations for Miss F’s ongoing and painful pelvic conditions with her during this admission. The Trust said it explained that thrush infection was a possibility though Miss F was on treatment her private gynaecologist had given her at the time. The Trust said it also explained that viral infection or genital herpes was a possibility though a viral swab did not detect herpes. The Trust said a third possibility could have been neuropathic pain (pain caused by nerve damage). For this reason, the Trust’s clinical staff arranged an outpatient referral to the pain team, women’s health physiotherapy clinic and discussed a trial of amitriptyline (medication used to treat various types of pain).

61. The Trust’s response says staff also explained other possible causes of chronic pelvic pain are endometriosis, PID, or major pelvic adhesions (scar tissue that can cause tissue or organs to stick together). The response explains that Miss F had already had treatment for PID and the likelihood of new onset PID was very low. The Trust said adhesions were also unlikely as Miss F had not had major pelvic surgery. The Trust said an MRI scan could detect major pelvic adhesions or endometriosis.

62. Having also consulted Miss F’s medical records from her further admission on 2 May 2025, we note there seems to be general clinical agreement acute pelvic infection was unlikely, and endometriosis a definite possibility to be ruled out. The gynaecological team also gave Miss F advice for treating her candida infection.

63. Our gynaecologist explained Miss F’s particular acute presentation does not lead to a clear diagnosis, and it is possible for her pain to remain medically unexplained. Basic investigations conducted at the Trust during admission, such as ultrasound scanning, returned negative results. In this uncertain clinical situation, it is natural for doctors to discuss a range of possible diagnoses and treatments.

64. From the series of discussions the doctors attending Miss F had during this admission, it is documented they took note of the recommendations of her private gynaecologist (with regard to the findings of candida), although, tests conducted at the time did not confirm this condition.

65. Miss F’s clinical notes show the Trust’s gynaecology team recommended the following clinical plan: treatment of candida with nystatin (an antifungal medication); an outpatient MRI and outpatient gynaecological follow-up.

66. Miss F’s clinical records also state the Trust made arrangements for the chronic pelvic pain team to be involved in her clinical evaluation and management.

67. Our gynaecologist adviser also pointed out neither of the diagnoses listed by Miss F’s private gynaecologist (“vaginal dysbiosis and chronic urinary tract infections (UTI)”) would be expected to cause acute severe pelvic pain requiring hospital admission. This is also based on Miss F’s specific medical circumstances: she was on prophylactic antibiotics (prescriptions used to prevent a disease or an infection from spreading or recurring) for her repeat urinary infections, and a urine sample taken on admission showed no indication of active infection.

68. We asked our gynaecologist adviser if Miss F’s atypical clinical presentation required further investigations and/or a multidisciplinary approach (MDT - a multi-disciplinary team meeting is a meeting of clinicians with experience in different specialisms) to reach a conclusive diagnosis during her gynaecology admissions and recommend effective, long-term management. Our gynaecologist said the first line of approach would be ruling out endometriosis before resorting to any MDT escalation.

69. In the interests of accurately and robustly assessing whether the Trust had done everything we would expect under Miss F’s circumstances, we also consulted the General Medical Council good medical practice guidance. This says doctors must provide a good standard of care.

70. The guidance goes on to explain that in providing clinical care they must:

a) adequately assess a patient’s condition

b) carry out a physical examination where necessary

c) promptly provide (or arrange) suitable advice, investigation or treatment where necessary

d) propose, provide or prescribe drugs or treatment (including repeat prescriptions) only when they have adequate knowledge of the patient’s health and are satisfied that the drugs or treatment will meet their needs

e) propose, provide or prescribe effective treatment based on the best available evidence

f) follow guidance on professional standards in prescribing

g) consult colleagues or seek advice from their supervising clinician, where appropriate

h) refer a patient to another suitably qualified practitioner when this serves their needs.’

71. Based on what the Trust did over all these four admissions, having consulted bothMiss F’s full medical records, receiving clinical advice, and reviewing national guidance, we consider the Trust has acted in line with the principles of providing good clinical care.

72. We are very sorry to hear of Miss F’s experience and all the distressing physiological and psychological times she suffered. We recognise she has been through a distressing period of time and we do not doubt the impact this has had on her.

73. We hope we have reassured her on the care and treatment the Trust provided her with. We thank her for bringing her concerns up to us and for her time and efforts in reliving those difficult circumstances with us during our initial enquiries.

1. We have carefully considered Miss F’s complaint about East Suffolk and North Essex NHS Foundation Trust (the Trust). We are very sorry to learn of the circumstances Miss F is unhappy about. We understand Miss F’s frustration at not having a clear diagnosis to explain her long standing pain and ill health. We recognise this has had a significant impact on Miss F

2. We have decided to take no further action at this time because we do not see any indications of failings in the Trust’s care and treatment. We understand this has been, and continues to be, a very distressing experience for Miss F.