Webber Valerie, Miller Michelle E, Gustafson Diana L, Bajzak Krisztina
Division of Community Health and Humanities, Faculty of Medicine, Memorial University, St. John's, Newfoundland & Labrador, Canada.
Discipline of Obstetrics and Gynecology, Memorial University, St. John's, Newfoundland & Labrador, Canada.
Sex Med. 2020 Dec;8(4):757-766. doi: 10.1016/j.esxm.2020.07.001. Epub 2020 Aug 6.
Persons with vulvodynia (a chronic vulvar pain condition) suffer many barriers to diagnosis and treatment, several of which may be exacerbated by the sociocultural and geographical context in which they live.
We drew on the experiences of patients with vulvodynia who were living in small urban and rural communities to learn what they perceived as the major barriers to diagnosis and treatment as well as to probe for possible solutions.
For this qualitative case study, we conducted 3 focus groups with a total of 10 participants, drawn from patients seen at our academic tertiary referral center, with a goal of understanding their lived experience with vulvodynia.
The patient dialogue was coded into themes and temporally grouped to illustrate struggles and victories in diagnosis and treatment.
Participants confirmed that healthcare provider knowledge and attitudes as well as system challenges (specialist and allied healthcare provider availability) are major barriers to timely diagnosis. Of novel interest are other factors that exacerbate distress and delay diagnosis such as patients' inadequate knowledge of sexual functioning and sociocultural messages regarding "normal" sexual activity. Our work suggests that a disease prevention framework that includes comprehensive sexual education before or at the onset of sexual activity may be of benefit in reducing the burden of vulvodynia when added to strategies to increase healthcare provider knowledge and improve access to effective treatments.
While healthcare provider knowledge and attitudes are often at the forefront of barriers to diagnosis, our study suggests that to minimize patient distress and expedite diagnosis, resources must also be directed to promoting comprehensive sexual health education. Webber V, Miller ME, Gustafson DL, et al. Vulvodynia Viewed From a Disease Prevention Framework: Insights From Patient Perspectives. Sex Med 2020;8:757-766.
外阴痛患者（一种慢性外阴疼痛病症）在诊断和治疗上面临诸多障碍，其中一些障碍可能因他们所处的社会文化和地理环境而加剧。
我们借鉴了生活在城乡小社区的外阴痛患者的经验，以了解他们认为诊断和治疗的主要障碍，并探寻可能的解决方案。
在这项定性案例研究中，我们进行了3个焦点小组讨论，共有10名参与者，他们均来自我们学术性三级转诊中心的患者，目的是了解他们外阴痛的生活经历。
将患者的对话编码为主题，并按时间分组，以说明诊断和治疗中的困难与成功。
参与者证实，医疗服务提供者的知识和态度以及系统挑战（专科医生和相关医疗服务提供者的可及性）是及时诊断的主要障碍。新出现的有趣因素是其他加剧痛苦和延迟诊断的因素，例如患者对性功能的了解不足以及关于“正常”性活动的社会文化信息。我们的研究表明，在增加医疗服务提供者知识和改善有效治疗可及性的策略基础上，纳入性活动前或开始时全面性教育的疾病预防框架，可能有助于减轻外阴痛的负担。
虽然医疗服务提供者的知识和态度往往是诊断障碍的首要因素，但我们的研究表明，为了尽量减少患者痛苦并加快诊断，还必须将资源用于促进全面性健康教育。韦伯V、米勒ME、古斯塔夫森DL等。从疾病预防框架看外阴痛：患者视角的见解。性医学2020；8：757 - 766。
