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Incorporate vulvovaginal and pelvic pain conditions into core curricula of gynecology and obstetrics and continuing ed.

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I belong to a coalition of women and men (and their families and friends) that suffer from chronic pelvic/genital pain. Many of us have been searching for help for years without adequate diagnosis and treatment. Too many of us have had our pain and suffering dismissed over and over by doctor after doctor. 

We are writing to you regarding the urgent need for reform in the medical school and continuing education curricula. We are requesting that the diagnosis and treatment of chronic pain become part of the core curriculum of every gynecologist’s and obstetrician’s education. Tens of millions of women and men across America are suffering from chronic pelvic, genital, and/or sexual pain. Many of us have undergone multiple invasive diagnostic and therapeutic procedures that either have not helped or have made our pain worse. In many cases we have been told that our pain and suffering is ‘‘in our head.” 

The science of chronic pain has grown tremendously in the past decade but this updated science is not being taught to gynecologists and obstetricians. The education gap in neuroscience and neurobiology needs to be bridged urgently. We know that when left untreated, pain centralizes and in many cases can become relentless and excruciating, sometimes crippling women and men to the point of suicide. 

Pain sufferers often search for help for years before finding a gynecologist that diagnoses them and treats them. How can we be allowing this to happen when we know how dangerous it is to leave pain untreated? When will our voices be heard? When will our suffering be recognized? When will 'It is in your head' be banished and replaced with compassion and immediate and appropriate care? 

For successful outcomes, a multidisciplinary approach to diagnosing and treating vulvovaginal, penile and pelvic pain is imperative. Gynecologists, urologists, gastroenterologists, neurologists, pain management doctors and physical therapists must work together to decipher the cause of the pain. Is the pain stemming from a tight pelvic floor? Would physical therapy be the appropriate treatment? Is the pain stemming from a crushed or entrapped nerve? Would nerve blocks and nerve medicine be the appropriate treatment? Is the pain stemming from the bladder? 

Pain is rarely psychogenic in nature. Pain usually has a biological basis. If this is the case, why are gynecologists telling us that the physical pain we are feeling is psychological? When will they begin to learn and internalize that the nerves that innervate the pelvis can be the cause of excruciating and mind-altering pain? When will they begin to learn and internalize that the muscles that create our pelvic floor can be the cause of tremendous pain? When will they receive the education that they need in order to help the many people that walk into their clinics seeking diagnosis and treatment for their physical pain?        

It is crucial that practitioners and students in their residencies and fellowship programs receive training in the assessment and management of pudendal neuralgia, persistent genital arousal disorder, vulvodynia, interstitial cystitis, endometriosis, vestibulodynia, penile pain, ejaculatory pain, irritable bowel syndrome, pelvic floor dysfunction and a variety of peripheral neuropathies that occur commonly in the pelvic region. Lichen simplex, lichen sclerosis, and lichen planus are common skin disorders affecting the genitalia and also must be recognized. Many of us suffer from several of these conditions.               

Good pain management is essential. Gynecologists need to work collaboratively with pelvic floor physical therapists as this type of therapy can be an important part of treatment. Patients also need access to psychologists and therapists that specialize in pain. Cognitive behavioral therapy and mind-body relaxation training can help pain sufferers cope with the devastating ramifications of their condition. 

We are reaching out to you for help. We can no longer suffer in silence. The time for change has come. We will support you in your efforts to gather relevant research and create new curricula. We thank you for taking the time to read our stories. We turn towards you with hope, faith and healing in our hearts.  

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