Psychosocial Aspects of Health Care Experiences in Women With Vulvovaginal Pain: Patients and Physician Perspectives

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Date
2014-04-24
Authors
Boyer, Stéphanie Camille
Keyword
Genito-Pelvic Pain Penetration Disorder , Vulvovaginal Pain , Health Care , Biopsychosocial Model , Medical Training , Vulvodynia
Abstract
Vulvodynia, a common form of chronic vulvovaginal pain, is conceptualized as a multifactorial chronic pain condition. Research has examined the role of numerous physiological, psychological, and social factors in the development and maintenance of vulvodynia, however, health care experiences have not been closely examined in this clinical population. Three online studies were conducted to investigate the health care experiences of women with chronic vulvovaginal pain. Study 1 examined pelvic examination (PE) experiences in women with and without chronic pain during intercourse. During their last PE, women with pelvic and vulvovaginal pain reported significantly more pain and anxiety compared to women without pain during intercourse. Various predisposing (first PE experience), examination (quality of patient- physician interaction, physician gender), and psychological factors (vaginal penetration cognitions, body image) predicted PE ratings in women with and without pain during intercourse. Study 2 more broadly examined pain and adjustment in women with vulvovaginal pain. Pain-related beliefs (i.e., attributional style, perceived control) were related to health care variables and predicted adjustment. First, global attributions predicted depressive symptoms and pain-related cognitions/responses after controlling for pain severity and interference. Second, chance beliefs moderated the relationship between pain-related cognitions/responses and internal attributions. Third, women with higher chance and lower physician pain beliefs reported lower social support. Study 3 investigated the knowledge, attitudes, and comfort of Canadian medical residents in Family Medicine and Obstetrics and Gynecology (OBGYN) about vulvodynia. OBGYN residents later in their training reported greater knowledge and comfort with vulvodynia and its symptoms than their more junior counterparts; ratings did not significantly differ between specialties. Residents did report significantly more positive attitudes toward patients with ii vulvovaginal pain of identifiable pathology in comparison to patients with no physical findings. Comfort discussing sexuality in medical practice was a significant predictor of knowledge, attitudes, and comfort with vulvodynia after controlling for demographics/training variables. These findings offer a multidimensional perspective on the role of health care in biopsychosocial models of vulvovaginal pain, and have implications for the assessment and treatment of vulvodynia and Genito-Pelvic Pain/Penetration Disorder.
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