Barriers to specialty care among patients with vulvovaginal symptoms: findings from a retrospective cohort of vulvovaginal clinic patients

Vulvovaginal conditions are common among patients in the US, with lifetime prevalence of upward of 16%, and 7%-8% of women experiencing symptoms by age 40.1 Vulvovaginal conditions include infections and vaginosis (eg, vulvovaginal candidiasis, bacterial vaginosis), dysplasia, dermatoses, pain syndromes (eg, vulvodynia), and structural problems. All these conditions may influence mental health, psychological well-being, and sexual satisfaction and functioning. However, studies suggest that more than half of those who experience vulvovaginal conditions—especially vulvar pain—do not seek care for their symptoms.2,3 It is possible that vulvovaginal conditions themselves may prevent patients from seeking care. In one US-based study, women with chronic vulvar pain were more likely to report perceived negative stereotypes about their pain overall, including from doctors, than women without chronic vulvar pain.3 Perhaps more strikingly, women who sought care for their pain were more likely to report these negative stereotypes from doctors, compared to women who did not seek care.3 Qualitative explorations of barriers to care for patients with vulvovaginal conditions commonly report barriers to care that include: comorbid mental health conditions, minimization of symptoms from health care providers, and lack of accurate information regarding vulvovaginal conditions for providers and patients alike.4 Reluctance to seek care, delays in diagnosis and misdiagnoses, and institutional barriers to high-quality or specialty care may prevent patients from receiving adequate treatment and may also exacerbate vulvovaginal symptoms.4