(191) PELVIC AND VULVOVAGINAL PAIN IN MEDICAL TRAINEES
Authors: Ponce S , Markarian E , Perelmuter S , Rubin R , Ferzandi T 
Published: December 2024

Abstract

Introduction
Chronic pelvic and vulvovaginal pain affects 15% to 20% of women, encompassing conditions such as endometriosis, adenomyosis, hypertonic pelvic floor dysfunction, vestibulodynia, and vulvar dermatoses such as lichen sclerosus. Despite its prevalence, both medical and public education on “pelvic pain” and treatment options are lacking. Individuals often face delays in diagnosis and adverse clinical experiences, leading to untreated conditions that heighten the risk of sexual dysfunction, diminished quality of life, anxiety, and depression. The financial burden of loss of productivity is also significant. Given these challenges, even medical trainees, who typically have better health literacy and access to health insurance, may struggle to receive appropriate care.

Objective
This study investigates the experiences of medical trainees with pelvic and vulvovaginal pain, identifies gaps in care, and assesses the impact on their medical training.

Methods
The study surveyed 66 medical students from four medical schools, each representing major geographical regions of the United States. Ob.Gyn residents were also recruited but excluded due to insufficient responses. Surveys utilized included the Vulvar Pain Questionnaire, Female Sexual Distress Scale, and Perceived Stress Scale, with additional questions on healthcare-seeking behavior, productivity, and medical education. Descriptive statistical analysis was performed.

Results
Of the 66 participants, 48.5% (n = 32) reported chronic pelvic or genitourinary pain, with 37.5% (n = 12) undiagnosed. The mean Vulvar Pain Functional Questionnaire score was 9.19 (SD 4.66), and the mean Sexual Distress Scale score was 24.06 (SD 12.77), ranging from 0 to 49.0. The Perceived Stress Scale score among those with pain was 20.08 (SD 6.96). Among participants with pain, 31.3% (n = 10) had not discussed their symptoms with a healthcare provider due to reasons such as dismissive attitudes from providers, uncertainty about the pain's reality, suspected psychological factors, busy schedules, and the inconvenience of explaining absences to their school. Of those who sought treatment, 55.0% (n = 10) reported improvement, while 44.4% (n = 8) experienced persistent pain. Additionally, 53.1% (n = 17) intended to seek further treatment. Some reported spontaneous resolution of pain, believed treatment was unnecessary, or were not offered treatment despite seeking care. Pelvic or vulvovaginal pain interfered with the medical school duties of 34.4% (n = 11) of participants. All participants acknowledged the importance of including pelvic pain diagnosis and management in medical training, yet, 96.9% (n = 31) felt their training lacked adequate educational content on this topic. In fact, 78.1% (n = 25) felt no better prepared to manage their conditions based on the education their medical school provided.

Conclusions
In summary, the study highlights significant gaps in care both due to persistent stigma, medical gaslighting, and inadequate education concerning chronic pelvic and vulvovaginal pain, impacting the well-being and professional duties of those who suffer with these conditions.

Disclosure
No.