Mistrust and barriers in the relationship between vulvar pain patients and physicians. Preliminary results of an anthropological study about pain experiences of vulvodynia in Italy

Background: Little is known about how patients with vulvar pain experience their relationships with physicians. Are doctor-patient interactions efficacious? Methods: I am developing an ethnographical study to explore experiences of vulvar chronic pain, a disabling condition still in course of recognition in Italy. Preliminary results originate from 17 in-depth-interviews with patients and physicians (pain specialists, gynecologists and physiotherapists), lasting from 50 to 150 minutes, voice recorded and analyzed according to thematic analysis. Results: Interviewees are white Italian females, mainly based in Milan and Rome. Patients’ ages range between 19– 57 years old, with diagnostic delay between 3 and 27 years. Illness narrative highlights medical nomadism and short- term therapeutic alliances characterized by mistrust and anger: pain is perceived as underestimated by doctors and sufferers are delegitimized disqualifying pain as not real or related to psychological disorders. Patients report frustrations and low motivations to engage in clinical alliances, and online forums are preferred sources of knowledge, limiting consults with physician to obtain pre-established prescriptions. Doctors confirm communication difficulties, highlighting risks for patients who pre-elaborate self-prognosis and treatments. Patients are perceived as undisciplined for the affective connection they try to establish, expecting emotional support beyond medical consults. Conclusions: The communication between vulvar chronic pain patients and physicians is characterized by incomprehensions about the role of pain and origins of the disease. Additionally, mistrust and unmatched expectations limit the therapeutic potential of the doctor-patient relationship. Preliminary results highlight the rising autonomy of patients for pharmaceutical therapy and professionals to consult.