Women seeking help for certain gynecological disorders may have their symptoms gaslighted by their doctors or nurses, a new study suggests.

The deluge of dismissive and invalidating comments from health care providers regarding disorders of the vulva and vagina can be profoundly damaging for women, often causing them to give up on seeking relief for their pain, as highlighted by researchers in a Thursday report in JAMA Network Open.

The research centered on patients at a vulvovaginal clinic who sought medical attention for an array of disorders that may lead to pain, sexual dysfunction, as well as bowel or bladder issues.

OB-GYN Dr. Chailee Moss, the principal author and an adjunct professor at George Washington University, mentioned that the research was initiated by “years of hearing these experiences from patients and realizing that the broader medical community wasn’t aware of how distressing these comments were to the 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.”

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. 

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.”

An important factor in providing care is paying attention to what the patient is saying, Dmochowski said. “A really critical part is listening to what the patient says,” he added. “Many patients have a very complicated presentation: pain, pelvic floor dysfunction, urinary problems, sexual issues. And each piece of the puzzle is important. Empathy is critical.”

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.