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A black and white issue? Learning to see the intersectional and racialized dimensions of gynecological pain

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Abstract

Population-based data suggest that African-American and Latina women in the United States are equally or more likely to complain of vulvar pain than are their White counterparts, yet these two groups of women remain largely missing from published clinical studies. This essay describes a set of interrelated variables that contribute to this discrepancy: (1) clinicians’ racialized perceptions of genital-sexual pain, and the diagnostic trajectories that map on to these perceptions; (2) discriminatory health-care practices that undertreat the pain of racial minorities; and (3) the stigmatized and “unmentionable” nature of genital pain, a condition for which up to half of symptomatic women do not seek treatment. I use the feminist theoretical concept of intersectionality to argue that racializing framing mechanisms intersect with well-documented discriminatory clinical practices and a gendered embarrassment unique to female genitalia, making it exceedingly difficult for Black and Latina women to report their vulvar pain to primarily White providers. I conclude by offering strategies by which all clinicians can better identify and treat the gynecological pain conditions of their Black and Latina patients.

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References

  • Ahmad, W.I.U. (Ed.) (1994) ‘Race’ and Health in Contemporary Britain. Buckingham, UK: Open University Press.

    Google Scholar 

  • Ahmed, S. (2007) A phenomenology of whiteness. Feminist Theory 8(2): 149–68.

    Article  Google Scholar 

  • Alexander, G.R. and Korenbrot, C.C. (1995) The role of prenatal care in preventing low birth weight. Future Children 5(1): 103–20.

    Article  Google Scholar 

  • Amaro, H. and Zambrana, R.E. (2000) Criollo, mestizo, mulato, latiNegro, indígena, white, or black? The US Hispanic/Latino population and multiple responses in the 2000 census. American Journal of Public Health 90(11): 1724–27.

    Article  Google Scholar 

  • American Psychological Association (APA) (2012) Diagnostic and Statistical Manual of Mental Disorders, 5th edition. New York: American Psychiatric Publishing.

    Google Scholar 

  • Anderson, J. (2006) Reflections on the social determinants of women’s health. Exploring intersections: Does racialization matter? Canadian Journal of Nursing Research 38(1): 7–14.

    Google Scholar 

  • Anderson, J. M., Reimer, K.S., Browne, A.J. and Lyman, M.J. (2007) Continuing the dialogue: postcolonial feminist scholarship and Bourdieu—discourses of culture and points of connection. Nursing Inquiry 14(3): 178–88.

    Article  Google Scholar 

  • Apte, G., Nelson, P., Brismée, J., Dedrick, G., Justiz, R. and Sizer, P.S. (2012) Chronic female pelvic pain – Part 1: Clinical pathoanatomy and examination of the pelvic region. Pain Practice 12(2): 88–110. doi:10.1111/j.1533-2500.2011.00465.x.

    Article  Google Scholar 

  • Aronowitz, R. (2008) Framing disease: An underappreciated mechanism for the social patterning of health. Social Science & Medicine 67(1): 1–9.

    Article  Google Scholar 

  • Basson, R., Leiblum, S., Brotto, L., Derogatis, L., Fourcroy, J., Fugl-Meyer, K., Graziottin, A., Heiman, J. R., Laan, E., Meston, C., Schover, L., van Lankveld, J. and Schultz, W.W. (2003) Definitions of women’s sexual dysfunction reconsidered: Advocating expansion and revision. Journal of Psychosomatic Obstetrics & Gynecology 24(4): 221–29.

    Article  Google Scholar 

  • Boardman, L.A., Cooper, A.S., Blais, L.R. and Raker, C. (2008) Topical gabapentin in the treatment of localized and generalized vulvodynia. Obstetrics & Gynecology 112(3): 579–85.

    Article  Google Scholar 

  • Boynton, P. (2015) There’s Something wrong with my vagina, but I’m too scared to see the doctor. Help. The Telegraph, January 30.

  • Bridges, K. (2009) Quasi-colonial bodies: An analysis of the reproductive lives of poor black and racially subjugated women. Columbia Journal of Gender and Law 18(2): 609–46.

    Google Scholar 

  • Bridges, K. (2011) Reproducing Race: An Ethnography of Pregnancy as a Site of Racialization. Berkeley: University of California Press.

    Google Scholar 

  • Brotto, L.A., Sadownik, L.A., Thomson, S., Dayan, M., Smith, K., Seal, B.N., Moses, M. and Zhang, A. (2014) A comparison of demographic and psychosexual characteristics of women with primary versus secondary provoked vestibulodynia. Clinical Journal of Pain 30(5): 428–35.

    Google Scholar 

  • Brown, C., Bachmann, G.A., Wan, J. and Foster, D. (2016) Pain rating in women with provoked vestibulodynia: Evaluating influence of race. Journal of Women’s Health 25(1): 57–62.

    Article  Google Scholar 

  • Brown, C.S., Foster, D.C., Bachour, C.C., Rawlinson, L.A., Wan, J.Y. and Bachmann, G.A. (2015) Presenting symptoms among black and white women with provoked vulvodynia. Journal of Women’s Health 24(10): 831–836.

    Article  Google Scholar 

  • Chalmers, J. and Moseley, L. (2016) Does your vulva hurt? You could have vulvodynia. The Conversation, June 1. https://theconversation.com/does-your-vulva-hurt-you-could-have-vulvodynia-55038.

  • Cho S., Crenshaw, K.W. and McCall, L. (2013) Toward a field of intersectionality studies: Theory, applications, and praxis. Signs 38(4): 785–810.

    Article  Google Scholar 

  • Cleeland, C.S., Gonin, R., Baez, L., Loehrer, P. and Pandya, K.J. (1997) Pain and treatment of pain in minority patients with cancer: The Eastern Cooperative Oncology Group Minority Outpatient Pan Study. Annals of Internal Medicine 127(9): 813–816. doi:10.7326/0003-4819-127-9-199711010-00006.

    Article  Google Scholar 

  • Clemens, J.Q., Link, C.L., Eggers, P.W., Kusek, J.W., Nyberg, L.M. and McKinlay, J.B. (2007) Prevalence of painful bladder symptoms and effect on quality of life in black, Hispanic, and white men and women. The Journal of Urology 177(4): 1390–94.

    Article  Google Scholar 

  • Collins, P.H. (2005) Black Sexual Politics: African Americans, Gender, and the New Racism. New York: Routledge.

    Google Scholar 

  • Connor, J.J., Brix, C.M. and Trudeau-Hern, S. (2013) The diagnosis of provoked vestibulodynia: Steps and roadblocks in a long journey. Sexual and Relationship Therapy 28(4): 324–35.

    Article  Google Scholar 

  • De Andres, J., Sanchis-Lopez, N., Asensio-Samper, J.M., Fabregat-Cid, G., Villanueva-Perez, V.L., ve Dolz, V.M. and Minguez, A. (2015) Vulvodynia – An evidence-based literature review and proposed treatment algorithm. Pain Practice. doi:10.1111/papr.12274.

    Google Scholar 

  • Dworkin, S. (2005) Who is epidemiologically fathomable in the HIV/AIDS epidemic? Gender, sexuality, and intersectionality in public health. Culture, Health & Sexuality 7(6): 615–23.

    Article  Google Scholar 

  • Einstein, G. and Shildrick, M. (2009) The postconventional body: Retheorising women’s health. Social Science & Medicine 69(2): 293–300.

    Article  Google Scholar 

  • Epstein, S. (2007) Inclusion: The Politics of Difference in Medical Research. Chicago: The University of Chicago Press.

    Book  Google Scholar 

  • Farrell, J. and Cacchioni, T. (2012) The medicalization of women’s sexual pain. Journal of Sex Research 49(4): 328–36. doi:10.1080/00224499.2012.688227.

    Article  Google Scholar 

  • Feagin, J. and Bennefield, Z. (2014) Systemic racism and U.S. health care. Social Science and Medicine 103: 7–14. doi:10.1016/j.socscimed.2013.09.006.

    Article  Google Scholar 

  • Foster, D.C., Sazenski, T.M. and Stodgell, C.J. (2004) Impact of genetic variation in interleukin-1 receptor antagonist and melanocortin-1 receptor genes on vulvar vestibulitis syndrome. Journal of Reproductive Medicine 49(7): 503–09.

    Google Scholar 

  • Freeman, H.P. (2014) Why black women die of cancer. The New York Times, March 13.

  • Frueh, J. (2003) Vaginal aesthetics. Hypatia 18(4): 137–58.

    Article  Google Scholar 

  • Garces, L.M. and Mickey-Pabello, D. (2015) Racial diversity in the medical profession: The impact of affirmative action bans on underrepresented student of color matriculation in medical schools. Journal of Higher Education 86(2): 264–94.

    Article  Google Scholar 

  • Glazer, Howard, and Rodke, Gae. (2002) The Vulvodynia Survival Guide: How to Overcome Painful Vaginal Symptoms and Enjoy an Active Lifestyle. Oakland: New Harbinger.

    Google Scholar 

  • Goldstein, A. and Burrows, L. (2008) Continuing medical education: Vulvodynia. Sexual Medicine 5(1): 5–15. doi:10.1111/j.1743-6109.2007.00679.x.

    Google Scholar 

  • Gordon, A.S., Panahian-Jand, M., McComb, F., Chiara Melegari, C. and Sharp, S. (2003) Characteristics of women with vulvar pain disorders: Responses to a web-based survey. Journal of Sex and Marital Therapy 29(1): 45–58.

    Article  Google Scholar 

  • Granot, M., Zimmer, E.Z., Friedman, M., Lowenstein, L. and Yarnitsky, D. (2004) Association between quantitative sensory testing, treatment choice, and subsequent pain reduction in vulvar vestibulitis syndrome. The Journal of Pain 5(4): 226–32.

    Article  Google Scholar 

  • Green, C.R., Anderson, K.O., Baker, T.A., Campbell, L.C., Decker, S., Fillingim, R.B., Kaloukalani, D.A., Lasch, K.E., Myers, C., Tait, R.C., Todd, K.H. and Vallerand, A.H. (2003) The unequal burden of pain: Confronting racial and ethnic disparities in pain. Pain 4(3): 277–94.

    Article  Google Scholar 

  • Haggerty, C.L., Peipert, J.F., Weitzen, S., Hendrix, S.L., Holley, R.L., Nelson, D.B., Randall, H., Soper, D.E., Wiesenfeld, H.C. and Ness, R.B. (2005) Predictors of chronic pelvic pain in an urban population of women with symptoms and signs of pelvic inflammatory disease. Sexually Transmitted Diseases 32(5): 293–99.

    Article  Google Scholar 

  • Harlow B.L., Kunitz C.G., Nguyen R.H., Rydell S.A., Turner R.M. and Maclehose R.F. (2014) Prevalence of symptoms consistent with a diagnosis of vulvodynia: Population-based estimates from 2 geographic regions. American Journal of Obstetrics & Gynecology 210(1): 40.e1–e8.

  • Harlow, B.L. and Stewart, E.G. (2003) A population-based assessment of chronic unexplained vulvar pain: Have we underestimated the prevalence of vulvodynia? Journal of the American Medical Women’s Association 58(2): 82–88.

    Google Scholar 

  • Harlow, B.L. and Stewart, E.G. (2005) Adult-onset vulvodynia in relation to childhood violence victimization. American Journal of Epidemiology 161(9): 871–80.

    Article  Google Scholar 

  • Harlow, B.L., Vazquez, G., MacLehose, R.F., Erickson, J., Oakes, M. and Duval, S. (2009) Self-reported vulvar pain characteristics and their association with clinically confirmed vestibulodynia. Journal of Women’s Health 18(9): 1333–40.

    Article  Google Scholar 

  • Harris, C.I. (2006) Whitewashing race: Scapegoating culture. California Law Review 94(3): 907–44. doi:10.15779/Z38J99P.

    Article  Google Scholar 

  • Holloway, K. (2011) Private Bodies, Public Texts: Race, Gender, and A Cultural Bioethics. Durham: Duke University Press.

    Book  Google Scholar 

  • Institute of Medicine (2005) Addressing racial and ethnic health care disparities: Where do we go from here? The National Academies. http://cretscmhd.psych.ucla.edu/healthfair/PDF%20articles%20for%20fact%20sheet%20linking/Addressing_health_disparities.pdf.

  • Jamieson, D.J. and Steege, J.F. (1996) The prevalence of dysmenorrhea, dyspareunia, pelvic pain, and irritable bowel syndrome in primary care practices. Obstetrics & Gynecology 87(1): 55–58.

    Article  Google Scholar 

  • Labuski, C. (2015) It Hurts Down There: The Bodily Imaginaries of Female Genital Pain. Albany: SUNY Press.

    Google Scholar 

  • Lavy R.J., Hynan L.S. and Haley R.W. (2007) Prevalence of vulvar pain in an urban, minority population. Journal of Reproductive Medicine 52(1): 59–62.

    Google Scholar 

  • Learman, L. (2005) Chronic pelvic pain – Part 1: Prevalence, evaluation, etiology, and comorbitities. Johns Hopkins Advanced Studies in Medicine 5(6): 306–15.

    Google Scholar 

  • Lurie, N. and Dubowitz, T. (2007) Health disparities and access to health. JAMA 297(10): 1118–1121.

    Article  Google Scholar 

  • Lynam, M.J. and Cowley, S. (2007) Understanding marginalization as a social determinant of health. Critical Public Health 17(2): 137–149.

    Article  Google Scholar 

  • Masheb, R.M., Brondolo, E. and Kerns, R.D. (2002) A multidimensional, case-control study of women with self-identified chronic vulvar pain. Pain Medicine 3(3): 253–59.

    Article  Google Scholar 

  • Mato, D. (1998) On the making of transnational identities in the age of globalization: The US Latina/o‐‘Latin’ American case. Cultural Studies 12(4): 598–620. doi:10.1080/09502386.1998.10383123.

    Article  Google Scholar 

  • Metzl, J. and Hansen, H. (2014) Structural competency: Theorizing a new medical engagement with stigma and inequality. Social Science & Medicine 103: 126–33.

    Article  Google Scholar 

  • Moynihan, R., Heath, I. and Henry, D. (2002) Selling sickness: The pharmaceutical industry and disease mongering. British Medical Journal 324(7342): 886–91.

    Article  Google Scholar 

  • National Institutes of Health (NIH), Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) (2012) Research Plan on Vulvodynia. http://www.nichd.nih.gov/publications/pubs/Documents/NIH_Vulvodynia_Plan_April2012.pdf.

  • Nygaard, I., Barber, M., Burgio, K.L., Kenton, K., Meikle, S., Schaffer, J., Spino, C., Whitehead, W.E., Wu, J. and Brody, D.J. (2008) Prevalence of symptomatic pelvic floor disorders in US women. JAMA 300(11): 1311–16. doi:10.1001/jama.300.11.1311.

    Article  Google Scholar 

  • Nguyen, R.H.N, MacLehose, R.F., Veasley, C., Turner, R.M., Harlow, B.L. and Horvath, K.J. (2012) Comfort in discussing vulvar pain in social relationships among women with vulvodynia. Journal of Reproductive Medicine 57 (3–4): 109–14.

    Google Scholar 

  • Nguyen, R.H.N., Reese, R. and Harlow, B.L. (2015) Differences in pain subtypes between Hispanic and non-Hispanic white women with chronic vulvar pain. Journal of Women’s Health 24(2): 1–7. doi:10.1089/jwh.2014.4892.

    Article  Google Scholar 

  • Nguyen, R.H.N., Turner, R.M., Rydell, S.A., MacLehose, R.F. and Harlow, B.L. (2013) Perceived stereotyping and seeking care for chronic vulvar pain. Pain Medicine 14(10): 1461–67. doi:10.1111/pme.12151.

    Article  Google Scholar 

  • Pagano, R. and Wong, S. (2012) Use of amitryptiline cream in the management of entry dyspareunia due to provoked vestibulodynia. Journal of Lower Genital Tract Disease 16(4): 394–97.

    Article  Google Scholar 

  • Parish, S. and Clayton, A. (2007) Sexual medicine education: Review and commentary. Sexual Medicine 4(2): 259–68.

    Article  Google Scholar 

  • Peacock, S. and Patel, S. (2008) Cultural influences on pain. Reviews in Pain 1(2): 6–9.

    Google Scholar 

  • Perry, B.L., Harp, K.L.H. and Oser, C.B. (2013) Racial and gender discrimination in the stress process: Implications for African American women’s health and well-being. Sociological Perspectives 56(1): 25–48.

    Google Scholar 

  • Reed B.D., Harlow S.D., Sen A., Legocki, L.J., Edwards, R.M., Arato, N. and Haefner, H.K. (2012) Prevalence and demographic characteristics of vulvodynia in a population-based sample. American Journal of Obstetrics and Gynecology 206(2): 170.e1–9.

  • Reed, B.D., Legocki, L.J., Plegue, M.A., Sen, A., Haefner, H. and Harlow, S.D. (2014) Factors associated with vulvodynia incidence. Obstetrics & Gynecology 123(2, Part 1): 225–31.

  • Reiter, R. (1990) A profile of women with chronic pelvic pain. Clinical Obstetrics and Gynecology 33(1): 130–36.

    Article  Google Scholar 

  • Roberts, D. (1997) Killing the Black Body: Race, Reproduction, and the Meaning of Liberty. New York: Vintage.

    Google Scholar 

  • Steinberg, A.C., Oyama, I.A., Rejba, A.E., Kellogg-Spadt, S. and Whitmore, K.E. (2005) Capsaicin for the treatment of vulvar vestibulitis. The American Journal of Obstetrics and Gynecology 192: 1549–53.

    Article  Google Scholar 

  • Street, R.L. (2003) Communication in medical encounters: An ecological perspective. In T. Thompson, A. Dorsey, K. Miller and R. Parrott (eds.) The Routledge Handbook of Health Communication (pp. 63–89). New York: Routledge.

    Google Scholar 

  • Street, R.L., Gordon, H. and Haidet, P. (2007) Physicians’ communication and perceptions of patients: Is it how they look, how they talk, or is it just the doctor? Social Science & Medicine 65(3): 586–98.

    Article  Google Scholar 

  • Tiefer, L. (2006) Female sexual dysfunction: A case study of disease mongering and activist resistance. PLoS Med 3(4): e178.

    Article  Google Scholar 

  • Tweedy, D. (2015) The Case for Black Doctors. The New York Times, May 15.

  • Villenas, S. (2006) Latina/Chicana feminist postcolonialities: Un/tracking educational actors’ interventions. International Journal of Qualitative Studies in Education 19(5): 659–672.

    Article  Google Scholar 

  • Vulvar pain: Not just a white woman’s issue (2011) Womanist Musings, January 26. http://www.womanist-musings.com/2011/01/vulvar-pain-not-just-white-womens-issue.html. Accessed July 28, 2015.

  • Zolnoun, D.A., Hartmann, K.E. and Steege, J.F. (2003) Overnight 5% lidocaine ointment for treatment of vulvar vestibulitis. Obstetrics & Gynecology 102(1): 84–87.

    Google Scholar 

  • Zondervan, K.T., Yudkin, P.L., Vessey, M.P., Jenkinson, C.P., Dawes, M.G., Barlow, D.H. and Kennedy, S.H. (2001) The community prevalence of chronic pelvic pain in women and associated illness behavior. British Journal of General Practice 51(468): 541–47.

    Google Scholar 

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  1. Program in Women’s and Gender Studies, Department of Sociology, Virginia Polytechnic Institute and State University, 518 McBryde Hall 0137, Blacksburg, VA, 24061, USA

    Christine M. Labuski

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Labuski, C.M. A black and white issue? Learning to see the intersectional and racialized dimensions of gynecological pain. Soc Theory Health 15, 160–181 (2017). https://doi.org/10.1057/s41285-017-0027-4

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