Introduction to the Problem
Women seeking help for certain gynecological disorders may have their symptoms gaslighted by their doctors or nurses, a new study suggests.
The flood of dismissive and invalidating remarks by health care providers about disorders affecting the vulva and vagina can be devastating for women, sometimes leading them to abandon their search for help with their pain, researchers reported Thursday in JAMA Network Open.
Study Findings
The study focused on patients at a vulvovaginal clinic who were seeking medical care for a variety of disorders that may cause pain, sexual dysfunction, and bowel or bladder dysfunction, according to NBC News.
OB-GYN Dr. Chailee Moss, lead author and an adjunct professor at George Washington University, said the roots of the research lay in “the years and years of hearing such experiences from patients and feeling like the broader medical community didn’t know how distressing the comments were to patients.”
Moss and her colleagues devised a survey that included dismissive comments and behaviors patients regularly encounter, such as doctors telling women to lose weight, go to therapy or drink more alcohol to cope with pain.
The survey was completed by 447 women between August 2023 and February 2024. Some of the survey questions included:
- “Of the health care providers you have seen, how many made you feel your symptoms were ‘all in your head?’”
- “Have you ever been told that you just need to relax more?”
- “Have you ever been told your vaginal opening was just ‘too small?’”
- “Have you ever been told that you just ‘need a glass of wine’ or a similar suggestion?”
- “I have been told that the pain I experienced during my physical exam was normal despite reporting significant pain during the exam.”
Impact on Patients
The participants reported that an average of 43.5% of past practitioners were supportive. But more than a quarter of the providers were belittling and about 20% did not believe the patient.
Overall, just over 40% of the women were told they just needed to relax more, about 20% were recommended to drink alcohol, and 39.4% said they were made to “feel crazy.”
Many women said they stopped coming for care because they felt their concerns were not being met. An estimated 20% of the patients were referred to psychiatry without medical treatment.
“In particular the comment ‘Just have a glass of wine’ was a particularly pervasive piece of advice that pain patients reported was very distressing,” Moss said.
Expert Insights
The findings are significant because women whose conditions are dismissed may stop seeking medical care and experience a delayed diagnosis, the researchers said.
There are notable limitations to the study. It was conducted at one clinic and may not be representative of a diverse population. The researchers did not explore whether there were more problems with male or female caregivers, although Moss said a number of participants felt they were treated differently based on the clinician’s gender. And the survey was based on patient recall.
However, Moss believes similar results would be found in other centers.
Dr. Roger Dmochowski, a professor of urology, surgery and gynecology at the Vanderbilt University Medical Center, said the new report underscores what women with urinary and pelvic floor complaints often experience.
“It’s my impression that women are traditionally undertreated and their symptoms are minimized or marginalized,” Dmochowski said. “Women are persistently ignored or depreciated for their symptoms.”
What Women Should Do When Doctors Don’t Listen
Dmochowski said patients shouldn’t hesitate to go to a different provider.
"Don’t give up," he said. "A couple of negative experiences should not dissuade you from seeking care."
Dr. Alessandra Hirsch, an assistant professor of obstetrics and gynecology at the Columbia University Vagelos College of Physicians and Surgeons, wasn’t surprised by the study’s findings.
“In the whole medical community there’s a history to contend with providers not believing in women’s pain,” she said. “I was sad and upset to read the patients’ accounts, especially those with chronic pain syndromes, such as endometriosis, which doesn’t usually get a diagnosis for many, many years.”
Hirsch hopes doctors who read the study “try to avoid falling into these habits.”
It’s important for doctors to listen, Hirsch said.
“There is a chronic pain study that showed that patients who had providers they felt were attentive and listened to them scored lower on symptom severity,” she said.
A big part of the problem is that doctors don’t get much training in pelvic pain, Hirsch said. And the health care system makes doctors rush through exams.
Her advice to women: Move on if the exams feel uncomfortable, and recognize that gaslighting is a form of disrespect.
Conclusion
The study highlights a significant issue in healthcare where women’s symptoms are dismissed or minimized, leading to delayed diagnoses and inadequate treatment. It emphasizes the importance of healthcare providers listening to their patients and taking their symptoms seriously. Women should not hesitate to seek a second opinion or change providers if they feel their concerns are not being addressed.
FAQs
- Q: What is gaslighting in the context of healthcare?
A: Gaslighting refers to the practice of healthcare providers dismissing or minimizing a patient’s symptoms, making them feel like their experiences are not real or valid. - Q: What should women do if they feel their symptoms are being dismissed by their healthcare provider?
A: Women should not hesitate to seek a second opinion or change providers if they feel their concerns are not being addressed. - Q: Why is it important for healthcare providers to listen to their patients?
A: Listening to patients is crucial in providing adequate care and treatment. It helps build trust and ensures that patients receive the care they need. - Q: What can be done to address the issue of gaslighting in healthcare?
A: Healthcare providers should be trained to listen to their patients and take their symptoms seriously. The healthcare system should also be improved to allow for more time for patient exams and consultations.
