Sexual pain affects almost 20% of women across the world and in the United States somewhere between 8% and 20% depending on who you read. It’s been associated with a lot of physical disability, sexual dysfunction, psychiatric disability and excessive healthcare costs. The problem is because it’s sexual pain it’s something that women don’t talk about, so patients often just suffer in silence which is terrible. Also, providers are not very well trained to take care of patients. So, there’s a huge mismatch between the need and the actual resources that are available. There are 43,000 gynecologists in the United States. We have about 14 million women living with this kind of pain, and less than 1% of those gynecologists are trained to take care these types of gynecologic pain.
Any provider who has contact with a female patient is able to screen for genital pain, and it’s easy to do. Just ask the patient if she’s had any kind of discomfort during intercourse or during the physical exam when they have annual Pap smears. If you do a pelvic exam you want to rule out the obvious causes of infection or bleeding, or neoplasm. Once you’ve done that, then you can initiate therapy just to help the patient with her pain. One of the most common therapies that we use in these types of patients is pelvic floor physical therapy. 10 years ago people didn’t even know what a pelvic floor physical therapist was, but nowadays it’s much more common to be able to find a pelvic floor physical therapist to help the patient deal with her pain. The other thing to keep in mind is that chronic genital pain is no different than any other chronic pain in as far as psychiatric and psychological comorbidity. We use many of the same therapies in our genital pain patients. So for analgesia we’ll use your typical analgesics that you use in chronic pain patients, such as tricyclic antidepressants, anticonvulsants. I think that what people don’t realize is that some therapy and just being able to believe and validate your patient goes a long way when compared to doing nothing and just ignoring it. And so if you can just initiate therapy and then when you get the chance get the patient to a specialist, that would be a lot more helpful to our patients. It’s important to recognize that this type of pain is not a psychological problem. A lot of people think that conditions like vulvodynia come about because the patient is depressed or it’s a psychological pain that they’re making up. I think it stands to reason that patients may not necessarily be looking for a pain cure but rather for some relief and for some social support and validation. I think if we can do those things, we’ll go a long way.