Medical Gaslighting Common in Vulvovaginal Care

TOPLINE:

In a cross-sectional study of 447 patients with vulvovaginal disorders, 52.8% considered ceasing care due to unaddressed concerns, while 39.4% reported being made to feel ‘crazy’ — rated as the most distressing behavior with a mean distress score of 7.39 out of 10. Patients reported that only 43.5% of past practitioners were supportive, while 26.6% were belittling and 20.5% did not believe their symptoms.

METHODOLOGY:

• A cross-sectional study analyzed survey responses from 447 patients (mean age, 41.7 ± 15.2 years) establishing care at a vulvovaginal disorders referral clinic from August 2023 to February 2024.
• Researchers developed a patient-centered instrument called Gaslighting and Sexual Medicine with input from the National Vulvodynia Association and Tight-Lipped patient advocacy organization.
• Analysis included both quantitative data using descriptive statistics and qualitative data through clinical-qualitative method for content analysis of narrative responses.

TAKEAWAY:

• Patients had seen a mean of 5.50 ± 4.53 past clinicians, with only 43.5% of practitioners being reported as supportive, while 26.6% were described as belittling and 20.5% were reported as not believing patients’ symptoms.
• Among surveyed patients, 41.6% were told they just needed to relax more, 20.6% were recommended to drink alcohol, and 16.8% felt unsafe during medical encounters.
• Qualitative analysis of 1150 patient quotations revealed lack of clinician knowledge (247 quotations) and dismissive behaviors (211 quotations) as the most common themes.
• Older patient age was negatively associated with the number of past clinicians (Spearman ρ, −0.235; P < .001) and reported negative clinician behaviors, including being made to feel crazy (Spearman ρ, −0.192; P < .001).

IN PRACTICE:

“There is an urgent need for education supporting a biopsychosocial, trauma-informed approach to vulvovaginal pain and continued development of validated instruments to quantify patient experiences,” the authors of the study wrote.

SOURCE:

This study was led by Chailee F. Moss, MD, Centers for Vulvovaginal Disorders in Washington, DC. It was published online on May 8 in JAMA Network Open.

LIMITATIONS:

According to the authors, the survey instrument has not been statistically validated. The study was limited to a single clinic population with limited socioeconomic and racial diversity, potentially affecting generalizability to more diverse populations. Additionally, selection bias may be present as patients presenting to the clinic were often referred for more challenging conditions after multiple prior evaluations. The study population may also underrepresent those who ceased seeking care.

DISCLOSURES:

Jill Krapf, MD, reported being a medical advisor for Evvy and Pelva Health. Caroline Pukall, PhD, disclosed serving as a consultant for Pelva Health, Initiator Pharma, SPM Therapeutics, Inc, and the Swedish Agency for Health Technology Assessment and Assessment of Social Services. Andrew Goldstein, MD, reported being a part-time employee of Daré Bioscience, an advisor to the National Vulvodynia Association, serving on the board of directors of the Gynecologic Cancers Research Foundation, and an advisor for Leo, Strat Pharma, Nuvig, and Celldex. He also reported receiving research funding from Strat Pharma and Softwave outside the submitted work. Additional disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.