Academic journal article The Canadian Journal of Human Sexuality

Vulvodynia Attitudes in a Sample of Canadian Post-Graduate Medical Trainees

Academic journal article The Canadian Journal of Human Sexuality

Vulvodynia Attitudes in a Sample of Canadian Post-Graduate Medical Trainees

Article excerpt

Physicians play a critical role in addressing sexual health in medical practice, including pain during intercourse. Vulvodynia is a prevalent cause of pain, however, related training is limited and variable. In addition, physician attitudes toward pain and sexuality may affect behaviour and therefore patient outcomes. This study's objectives were to: 1) determine whether post-graduate trainees hold more positive attitudes toward women presenting with vulvovaginal pain with (versus without) an identifiable cause; and 2) examine attitudinal predictors of comfort treating vulvodynia and attitudes toward patients with this presentation. Residents in Canadian Obstetrics and Gynecology (OBGYN) and Family Medicine (FM) programs participated in an online survey (N = 99). Respondents completed questionnaires related to demographics, sexuality-related training, sexual attitudes, and comfort treating and attitudes toward vulvovaginal pain and its symptoms. Residents reported significantly more positive attitudes toward patients with visible pathology versus no identifiable cause for vulvovaginal pain, regardless of medical specialty, p < .001. In OBGYN residents, general comfort discussing sexuality in medical practice significantly predicted comfort treating vulvodynia and its symptoms (p < .001), and attitudes toward women with vulvodynia (p < .05). Demographic, training, and attitudinal variables did not significantly predict vulvodynia outcome measures in FM residents. This study of medical residents identified different attitudes based on vulvovaginal pain presentation, and identified predictors of attitudes and comfort treating vulvodynia in OBGYN residents. Findings suggest pathways by which health care experiences may influence outcomes in this population, and have important implications for resident training.

KEYWORDS: Genito-pelvic pain/penetration disorder, medical education, sexual attitudes, sexual health training, vulvodynia

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Vulvodynia is a multifactorial condition, defined as chronic vulvovaginal pain occurring without an identifiable cause (Bornstein et al., 2016). It has a lifetime prevalence rate of 8% in premenopausal women (Harlow et al., 2014), and a 3.1% annual incidence rate (Reed et al., 2012). This common women's health concern is associated with substantial economic burden, with a recent non-probability survey estimating its direct and indirect costs to be between 31 and 72 billion dollars annually in the United States (US) (Xie et al., 2012). Women with vulvodynia tend to experience pain in both sexual and non-sexual contexts (Bergeron, Binik, Khalife, Pagidas, & Glazer, 2001; Boyer & Pukall, 2014); however, chronic pain during sexual activities involving vaginal penetration (previously termed dyspareunia) is the most commonly reported symptom, and the associated sexual difficulties tend to characterize this condition (see Binik, 2010).

Medical trainees receive limited and variable education and training related to human sexuality, disproportional to its importance in medical practice (Coleman et al., 2013). A survey of North American undergraduate medical programs reported that the majority provide 3 to 10 hours of training for all human sexuality topics (Solursh et al., 2003), and many do not include formal sexual health curricula (Malhotra, Khurshid, Hendricks, & Mann, 2008). A survey of randomly selected primary care physicians and obstetricians and gynecologists (OBGYNs) in the US found that almost one half reported inadequate training in taking a sexual history from a female patient in medical school, and one third of each group reported the same in residency (Abdolrasulnia et al., 2010). With regards to post-graduate training, a recent survey of Canadian training programs found that half to two-thirds of the sexuality-related topics assessed had minimal to no coverage in over 50% of both Family Medicine (FM) and Obstetrics and Gynecology programs (Barrett et al. …

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