Gaslighting in vulvovaginal disorder care linked to patient distress

Gaslighting in vulvovaginal disorder care linked to patient distress | Image Credit: © bongkarn - © bongkarn - stock.adobe.com.

Past experiences with gaslighting and substantial distress are common among patients with vulvovaginal disorders, according to a recent study published in JAMA Network Open.¹

Understanding epistemic injustice

An injustice related to knowledge and knowing is referred to as epistemic injustice, which may prevent a patient from obtaining or sharing knowledge about their experiences. This includes gaslighting, in which dismissal causes a person to question their perception of reality. Increased vulnerability to gaslighting has been reported in medicine.²

“The association of epistemic injustice with patients’ perception of care or willingness to seek care has not been described in the unique context of vulvovaginal pain, nor do patient-centered instruments exist to characterize such associations,” wrote investigators.¹

Assessing vulvovaginal pain context

The cross-sectional study was conducted to evaluate patient experiences among individuals with vulvovaginal disorders. Investigators evaluated testimonials from these patients provided by the National Vulvodynia Association website, extracting common themes to design a survey instrument.

There were 37 items included on the instrument, referred to as Gaslighting And Sexual Medicine. Participants completed the survey through Survey Monkey, filling out quantitative questions and open-text fields. These were designed to quantify clinician behavior and consequent distress.

Open-text fields were placed after each survey item to allow for elaboration beyond a patient’s numerical response. Numerical responses included multiple choice options, binary yes or no fields, and 0 to 10 numerical scales.

Demographic collection and additional measures

Patients with care at a center for vulvovaginal disorders before the initial consultation between August 2023 and February 2024 were offered the survey. Sociodemographic data such as age, race, and ethnicity were also obtained.

Additional measures included the Female Sexual Function Index, Female Sexual Distress Scale, and Pain Catastrophizing Scale. Mental health was also assessed with the Pain Anxiety Symptom Scale, Patient Health Questionnaire–9, and General Anxiety Disorder instrument.

There were 447 patients aged a mean 41.7 years included in the final analysis, with a mean 5.50 prior clinicians. Of these, patients reported 43.5% of clinicians being supportive, 31.7% belittling, and 20.5% did not believe the patient.

Commonly reported negative clinical experiences

Having normal physical examination findings despite significant pain was reported in 52.8% of patients, with 41.6% being told they need to relax more. Additionally, 20.6% were recommended to drink alcohol, 20.6% were referred to psychiatry without medical treatment, 16.8% felt unsafe during the encounter, and 39.4% were made to feel crazy.

Being made to feel crazy, a common definition of gaslighting, was the most significant form of distress among patients, with a mean distress score of 7.39 of 10. Of patients, 52.8% considered stopping care because of not having their concerns addressed, and 56.8% because they did not feel other practitioners could help them.

Significant reductions in distress and considering giving up on care were reported in patients with a greater prevalence of supportive behavior from past practitioners. Links between experiencing negative behaviors with numerical distress ratings and the prevalence of considering giving up were also reported.

Age, clinician turnover, and barriers to care

A negative correlation was reported between age and the number of past clinicians, alongside all reported negative clinician behavior. Barriers to care were the most common themes observed. These often led to patients feeling frustrated by a clinician lack of knowledge or the need to see an extensive list of clinicians.

When assessing concerns about behavior, clinicians being dismissive or not listening to their patient was the most prevalent theme. This included poor bedside manner and ignoring physical symptoms to discuss mental health. Overall, the results indicated frequent dismissive behavior from clinicians toward patients with vulvovaginal disorders.

“Future work must be directed toward determining best practices for clinicians and interventions to reduce such harm,” wrote investigators.

References

1. Moss CF, Chinna-Meyyappan A, Skovronsky G, et al. Experiences of care and gaslighting in patients with vulvovaginal disorders. JAMA Netw Open. 2025;8(5):e259486. doi:10.1001/jamanetworkopen.2025.9486
2. Sebring JCH. Towards a sociological understanding of medical gaslighting in western health care. Sociol Health Illn. 2021;43(9):1951-1964. doi:10.1111/1467-9566.13367