Facilitators and barriers in the diagnostic process of vulvovaginal complaints (vulvodynia) in general practice: a qualitative study (original) (raw)
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Approach to the patient with vulvovaginal complaints
Dermatologic Therapy, 2010
Although vulvovaginal diseases may seem daunting, dermatologists possess all of the requisite tools and skills necessary to comprehensively assess and accurately diagnose primary cutaneous, systemic, and inflammatory diseases that affect the vulva. A simple but comprehensive dermatologic approach to the patient with a vulvovaginal complaint is presented. We begin with a review of the normal vulvar anatomy and normal variants and proceed to the clinical approach with special emphasis on the history, physical examination, and common diagnostic procedures.
Archives of Sexual Behavior
Vulvodynia is the experience of idiopathic pain characterized by burning, soreness, or throbbing in the external female genitalia or vulva and is estimated to be experienced by 4-16% of the female population, yet only half of women seek help regarding their symptoms. Of the women who do seek help, only around 2% obtain a diagnosis. Therefore, the aim of the current study was to explore the experiences of women with vulvodynia on their journey toward diagnosis, by using semi-structured interviews and an interpretative phenomenological analysis (IPA) methodology. Eight women were interviewed, and their experiences were analyzed and interpreted into three master themes, each with constituent sub-themes: (1) The Journey Is a Battle, (2) "What Is Vulvodynia?": Ambivalence Toward Diagnosis, and (3) Patriarchy, Women, and Sex. Overall, women perceived a healthcare system which was dismissive and shaming, with an inadequate knowledge of vulvodynia. This in turn impacted on women's psychological well-being. Psychological understanding, one-to-one therapy, and consultation and training for healthcare professionals may help to improve the psychological well-being of women with vulvodynia.
American Journal of Obstetrics and Gynecology, 2003
OBJECTIVES: This study was undertaken to assess sexual function and quality of life of women after evaluation and treatment of vulvovaginal problems at a University Center. STUDY DESIGN: Subjects were mailed a cover letter and follow-up survey. All new patients (322) referred for evaluation of vulvar problems at a University Vulvar Specialty Clinic between January 1, 1996, and December 31, 1999, were mailed a survey instrument containing specific questions concerning general, vulvar, and sexual health. Medical records from clinic visits were manually abstracted. Groups defined with descriptive statistics and proportional change in symptoms analyzed with χ 2 statistics. RESULTS: Of the 322 women who met the study criteria, 195 returned valid surveys for an overall response rate of 60.5%. The mean duration of follow-up was 28 months. The most common presenting symptoms were vulvar pain (86%), dyspareunia (71%), itching (35%), and skin changes (20%). At follow-up, 128 (66%) reported improvement in symptoms compared with 14 (7%) that worsened (P < .001). Although subjects did not report an increase in the frequency of sexual activity, significantly more women reported an increase in enjoyment (n = 77, 43%) of sexual activity than a decrease (n = 30, 17%, P < .001). CONCLUSION: Most women presenting for evaluation of vulvar pain will report improvement in symptoms and sexual function after treatment in a Vulvar Specialty
BJGP Open, 2017
BackgroundA recent Dutch study in general practice showed a clear relationship between the diagnosis of vulvovaginal candidiasis (VVC) and symptoms suggestive of provoked vulvodynia (PVD). PVD accounts for the largest group of vulvar pains, but is often not recognised by GPs.AimTo investigate whether diagnostic uncertainty about VVC in general practice could also point to the diagnosis of PVD, and whether and how this diagnostic uncertainty affects management.Design & settingAn observational study in 2014 in Dutch general practices of the NIVEL Primary Care Database.MethodWomen with an uncertain diagnosis of VVC were distinguished from those with certain VVC based on the occurrence of recurrent episodes and persisting complaints, despite treatment. Factors known to be associated with PVD were hypothesised to be more prevalent in women with uncertain VVC. Data on symptom management by GPs were collected.ResultsIn total 7066 women with VVC or uncertain VVC were included. Uncertain VVC...
Family medicine and care, 2018
Introduction: Bacterial vaginosis (BV) is the most common vaginal infection among women of reproductive age. Recent research shows women often feel dissatisfied with the management of BV in general practice. Few data are available on general practitioners (GPs) management of BV in Australia. This study explored GPs views and practices in the management of BV. Methods: A pilot qualitative study was undertaken in which eight GPs were purposively recruited to participate in one-on-one semi-structured interviews. Interviews were recorded, transcribed verbatim and analysed thematically. Results: GPs did not consider BV a serious condition, had poor levels of knowledge around BV-related sequelae and risk factors, used varying and inconsistent diagnostic and treatment practices, and rarely asked women about self-management of symptoms. Most GPs recognised BV could have some psychosocial impact on women's lives; those with an interest in sexual health tended to be more empathetic. Major barriers to the improved management of BV in general practice included a lack of time, a lack of training and knowledge, and discomfort discussing sexual health issues particularly among male GPs. Conclusion: Past research has shown women want more sensitive and consistent management of BV in general practice. BV management in general practice could be enhanced through improved awareness of BV-related risk factors and sequelae and women's use of self-help remedies. Women need well-informed, evidence-based advice around optimal management and risks for BV.
Health Education on Vulvovaginitis for Women Seen at a Family Health Center
2014
Objective: To develop educational activities, aiming at the construction of knowledge about vulvovaginitis, identifying the knowledge acquired and the desire for attitude change after the activities. Methods: A qualitative descriptive research, held at Maria Adeodato Family Health Center (FHC) in the city of Sobral, Ceará, in the period from March to May 2013. Ten educational activities regarding vulvovaginitis were performed with women seen at the FHC, addressing different topics. Every action was divided into three phases: diagnosis of prior knowledge, educational activities with the subject to be covered, and afterwards evaluation. Data was collected through semi-structured interview, for the participant's identification, and focal group, for the diagnostic and evaluation phases, and content analysis was performed using thematic categories. Results: The research comprised 8 participants, aged between 48 and 55 years, with schooling ranging from the first year of primary education to complete primary education, mostly single, having a minimum of 5 children, and the participants did not undergo the gynecological exam frequently. The generated analysis categories were described as 'women's knowledge of the body (genitals) and their intimate hygiene', 'prevention and control of vulvovaginitides' and 'women's perception about gynecological exam'. It was evidenced that the study participants ignored the terminology 'vulvovaginitis' as well as the disease signs, symptoms, and means of transmission, or just had a brief knowledge of the subject. Conclusion: After the educational activities, the study identified knowledge acquirement by the participants and expressions indicating the desire for changing.
Vaginal Construction and Treatment Providers' Experiences: A Qualitative Analysis
Journal of pediatric and adolescent gynecology, 2018
To investigate specialist clinicians' experiences of treating vaginal agenesis. Semi-structured interviews. Twelve hospitals in Britain and Sweden. Thirty-two health professionals connected to multidisciplinary teams (MDTs) including medical specialists and psychologists. Theoretical thematic analysis of recorded verbatim data. The gynecologist and psychologist interviewees share certain observations including the importance of psychological readiness for and appropriate timing of treatment. Three overlapping themes are identified in our theoretical analysis of the MDT clinicians' talk: (1) the stigma of vaginal agenesis and the pressure to be "normal" can lead patients to minimize the time, effort, physical discomfort, and emotional cost inherent in treatment. (2) Under pressure, treatment might be presented to patients with insufficient attention to the potential psychological effect of the language used. Furthermore, the opportunity to question what is "nor...
Women with vulvodynia: awareness and knowledge of its care among student healthcare staff
Scandinavian journal of caring sciences, 2017
Many women with vulvodynia are women of fertile age, and this syndrome may cause many physical and psychosexual functional disorders. Women with vulvodynia often find that healthcare professionals seem to demonstrate a lack of awareness about the syndrome and its care. These issues have not been previously studied among student healthcare staff. To investigate awareness and knowledge about vulvodynia and its care among staff in the student healthcare sector in Finland. The study design was cross sectional. A survey instrument called 'Awareness and knowledge of vulvodynia and its care' was developed for this study and was used for data collection. The data were collected from a web-based survey conducted with student healthcare professionals (N = 191, n = 79) in all 13 student healthcare units in Finland. Descriptive statistical methods were used to describe the connections between the factors associated with awareness of vulvodynia and its care. Ethical standards were follow...
Treatment Seeking for Vulvodynia and Vaginismus: A Systematic Review
New Voices in Psychology 8(2): 53-70
This systematic review synthesises the current literature regarding treatment seeking decisions in women with vulvodynia and vaginismus. A database search was conducted to identify literature of interest, including both qualitative and quantitative research. Of the 555 related articles, nine were deemed eligible. Findings suggest that treatment seeking can be a protracted process that has significant implications for women with vulvodynia and vaginismus. The women's attitudes, perceptions and distress levels impact treatment seeking, with relationship factors and selfconcept affecting motivation for treatment seeking. Knowing what motivates treatment seeking could improve the rates of diagnosis and successful treatment, thus improving the quality of life for women with vulvodynia and vaginismus.
Vulvodynia Viewed From a Disease Prevention Framework: Insights From Patient Perspectives
Sexual Medicine Open Access, 2020
Introduction: Persons with vulvodynia (a chronic vulvar pain condition) suffer many barriers to diagnosis and treatment, several of which may be exacerbated by the sociocultural and geographical context in which they live. Aim: We drew on the experiences of patients with vulvodynia who were living in small urban and rural communities to learn what they perceived as the major barriers to diagnosis and treatment as well as to probe for possible solutions. Methods: For this qualitative case study, we conducted 3 focus groups with a total of 10 participants, drawn from patients seen at our academic tertiary referral center, with a goal of understanding their lived experience with vulvodynia. Main Outcome Measures: The patient dialogue was coded into themes and temporally grouped to illustrate struggles and victories in diagnosis and treatment. Results: Participants confirmed that healthcare provider knowledge and attitudes as well as system challenges (specialist and allied healthcare provider availability) are major barriers to timely diagnosis. Of novel interest are other factors that exacerbate distress and delay diagnosis such as patients’ inadequate knowledge of sexual functioning and sociocultural messages regarding “normal” sexual activity. Our work suggests that a disease prevention framework that includes comprehensive sexual education before or at the onset of sexual activity may be of benefit in reducing the burden of vulvodynia when added to strategies to increase healthcare provider knowledge and improve access to effective treatments. Conclusion: While healthcare provider knowledge and attitudes are often at the forefront of barriers to diagnosis, our study suggests that to minimize patient distress and expedite diagnosis, resources must also be directed to promoting comprehensive sexual health education.