Sameena Rahman, MD, on bias, dismissed diagnoses, and the vulvar vestibule

The term "brown girls' disease"—used dismissively in clinical settings to describe South Asian women presenting with vaginismus—is the title of a new book by Sameena Rahman, MD, FACOG, MSCP, IF, founder of The GYN & Sexual Medicine, who reclaimed the phrase deliberately to expose a pattern of bias in medicine that extends well beyond any single condition or patient population.

Rahman described hearing the term from other South Asian ob-gyns and recognizing it as not an isolated incident at one institution but a national phenomenon. Her own training had included an attending asking, in reference to a South Asian patient with vaginismus, "What's the deal with your people? They act like they've never had anything in their vagina." "You can feel it and you can see it and you can actively watch them do it," she said of the eye rolls and dismissals she witnessed repeatedly. The pattern she observed was not just attitudinal but clinical: the assumption that vaginismus in a South Asian patient was explained by culture short-circuited the differential.

"No one's looking at—did anyone look at her vulvar vestibule to see if it was inflamed, if she had any hormonal issues, any neuropathologic issues? There's a lot to the equation," Rahman said. "Sexual medicine is biopsychosocial. There is obviously a cultural component, but it's not the diagnosis, it's context."

The book, she emphasized, is not written only for South Asian readers or patients. It uses the reclaimed phrase as a lens for examining dismissal in women's sexual medicine broadly—dismissed terms like "brown girls' disease," dismissed diagnoses like endometriosis, perimenopause, and persistent genital arousal disorder, and dismissed anatomy like the vulvar vestibule.

"That's really the crux of the book—dismissal in sexual medicine specifically, and how it impacts our ability to provide the best care as ob-gyns, and the patient's ability to access the best care and their desire to come forward," she said.

The conditions her book covers—vaginismus, PGAD, low libido, vestibulodynia—are underrepresented in research and underaddressed in training for interconnected reasons. Less than 1% of women's health research funding goes to vulvovaginal and sexual medicine, Rahman noted, and much of what exists is self-funded through organizations like the International Society for the Study of Women's Sexual Health. The educational gap is compounding: She described a fourth-year ob-gyn resident who, during a brief session Rahman gave on vestibulodynia, said she had never heard the term and was uncertain where the vulvar vestibule was located.

"We're supposed to be the champions of women's health," Rahman said. She describes herself as the "PR for the vulvar vestibule—the most dishonored tissue in ob-gyn and women's health."

The clinical encounter structure itself is a barrier.

"You cannot get a full investigation for sexual medicine concerns in 15 minutes," Rahman said, noting that this was part of her decision to step outside the insurance model. When clinicians do raise sexual health topics proactively, patients respond.

"Studies show time after time—if the provider brings it up, they're more likely to say, ‘yes, I do have libido issues,’ " she said. "If you normalize the conversation, it opens the floodgates."