Racial and Ethnic Gaps Found in Treatment of Chronic Vulvar Pain

Understanding Chronic Vulvar Pain and Its Impact

Chronic vulvar pain, known medically as vulvodynia, affects millions of women in the United States. Yet for many, the journey to a diagnosis is long and frustrating. The condition involves persistent pain or discomfort in the vulvar area that lasts for more than three months. Doctors often cannot find a clear cause, which makes treatment challenging. For women living with this condition, everyday activities like sitting, exercising, or having sex can become painful. The emotional toll is significant, too. Many women report feeling isolated, anxious, or depressed because their pain is not taken seriously by others or by healthcare providers.

This new study presented at the American College of Obstetricians and Gynecologists (ACOG) annual meeting highlights a troubling pattern. Black and Hispanic patients are not receiving the same level of care as white and non-Hispanic patients. Instead of getting targeted treatments that address the pain directly, Black and Hispanic patients are more often given general pain relievers. These medications may help with symptoms temporarily, but they do not treat the underlying condition. This gap in care can lead to more suffering and longer recovery times for women of color.

What the Study Found

Researchers led by Mitali Sharma, BS, of the Case Western Reserve University School of Medicine in Cleveland, analyzed 48,262 patient records from the TriNetX Clinical Research Database. All patients had an ICD-10 code for vulvodynia. The majority of patients were white (33,566) and non-Hispanic (32,433). Black patients numbered 3,037, and Hispanic patients numbered 3,049. White patients were more likely to receive vulvar excision procedures and treatments such as vaginal estrogens, antidepressants, and benzodiazepines. Black and Hispanic patients were more often prescribed general pain relievers.

This difference matters because general pain relievers like ibuprofen or acetaminophen may dull the pain but do not fix the root problem. Targeted treatments such as vaginal estrogen creams or certain antidepressants can help calm the nerves in the pelvic area. These medications are specifically used for vulvodynia and are backed by medical guidelines. When patients do not receive these treatments, their pain may continue for years.

Why These Gaps Exist

Sharma pointed out that pain management may differ across racial and ethnic groups because of long-standing inequalities in healthcare. These inequalities are not new. For decades, research has shown that Black and Hispanic patients receive less effective pain treatment than white patients for conditions ranging from broken bones to cancer pain. The same pattern now appears to hold true for vulvodynia.

One factor is how symptoms are described. A 2015 study found that Black women often described their vulvodynia as “aching,” while white women used words like “burning.” Sharma said this difference could lead to delays in diagnosis. Doctors may not recognize “aching” as a sign of vulvodynia because the medical literature has historically focused on “burning” as the classic symptom. This does not mean patients are describing their pain wrong. It means the medical system needs to listen better.

Sharma also noted that before running any analyses, her team noticed that white and non-Hispanic patients make up the vast majority of those with a documented diagnosis code for vulvodynia. This may not reflect the true number of people with the condition. Instead, it could be due to how symptoms are reported, how they are described, whether doctors recognize them, and what treatments are offered. In other words, many Black and Hispanic women may have vulvodynia but never get formally diagnosed.

How This Affects Readers

If you are a woman of color living with chronic vulvar pain, this study may confirm what you have already experienced. You may have visited multiple doctors over several years before learning what is wrong. You may have been told your pain is “in your head” or that you just need to relax. You may have been given a prescription for ibuprofen and sent home. This is not your fault. The healthcare system has blind spots when it comes to treating pain in minority populations.

For white women, this study is a reminder that your experience may not be universal. The care you receive may be better because of how the system works, not because your pain is more real. Understanding these gaps can help you advocate for friends and family members who may not be getting the same level of care.

For all women, this study underscores the importance of speaking up about your symptoms. If you feel your pain is not being taken seriously, ask for a second opinion. Ask specifically about vulvodynia. Ask if targeted treatments like vaginal estrogen or nerve pain medications might help you.

What Experts Generally Say

Healthcare experts who study health disparities often point to several root causes for these gaps. Implicit bias among healthcare providers can affect how they interpret symptoms. A doctor may unconsciously think a Black patient’s pain is less severe than a white patient’s pain. This bias has been documented in multiple studies across different medical fields. Another factor is access to care. Black and Hispanic patients are more likely to live in areas with fewer specialists, including gynecologists who are trained to diagnose and treat vulvodynia. They may also face financial barriers that make it harder to afford specialist visits or prescription medications.

Experts also emphasize that the medical community needs better training on how vulvodynia presents in different populations. The classic “burning” symptom may not apply to everyone. Doctors need to learn that “aching” or “pressure” or “stabbing” can all be signs of vulvodynia. They also need to ask about these symptoms more routinely during checkups. Many women do not volunteer information about vulvar pain because they feel embarrassed or think it is normal. A simple question from a doctor can open the door to proper care.

Practical Takeaways for Patients

If you are experiencing chronic vulvar pain, here are steps you can take to get better care:

• Keep a symptom diary. Write down when the pain happens, what it feels like, and what makes it better or worse. Use your own words. Do not try to match what you think doctors want to hear.
• Ask directly about vulvodynia. Say, “Could this be vulvodynia?” or “I have chronic vulvar pain and want to be tested for vulvodynia.” This puts the condition on the table.
• Seek a specialist. If your primary care doctor or general gynecologist is not helping, ask for a referral to a pelvic pain specialist or a vulvar clinic. These specialists are more likely to know about targeted treatments.
• Bring a friend or family member to appointments. Having someone with you can help you remember what the doctor says and can also serve as an advocate if you feel dismissed.
• Ask about specific treatments. Inquire about vaginal estrogen, antidepressants used for nerve pain (like amitriptyline or nortriptyline), benzodiazepines for pelvic floor tension, or physical therapy. These are standard treatments for vulvodynia.
• Do not settle for general pain relievers. If a doctor offers only ibuprofen or acetaminophen, ask why. Ask if there are more targeted options. If the doctor cannot give a clear answer, consider a second opinion.

What Needs to Change in Healthcare

This study adds to a growing body of evidence that racial and ethnic disparities in pain treatment are widespread. Experts say that healthcare systems need to do more than just acknowledge these gaps. They need to take action. This includes training doctors to recognize their own biases, diversifying the medical workforce so that patients see providers who look like them, and updating clinical guidelines to reflect how symptoms may differ across populations.

Researchers also need to include more Black and Hispanic women in studies on vulvodynia. If most studies are done on white women, the results will only apply to white women. Treatments that work for one group may not work as well for another. Without diverse research, the gaps in care will only continue.

Sharma and her team did not look at age or menopausal status in this study. Future research should examine how these factors interact with race and ethnicity. For example, older women and postmenopausal women may have different treatment needs. Understanding these nuances will help doctors provide personalized care for every patient, regardless of background.

Final Thoughts

Chronic vulvar pain is a serious condition that deserves serious treatment. No woman should have to suffer for years because of her race or ethnicity. This study is a wake-up call for the medical community. It shows that even in a condition that is already underdiagnosed and undertreated, there are further disparities based on skin color. The goal should be equal care for equal pain. Until that happens, patients must advocate for themselves, and doctors must listen more carefully. The pain is real. The treatment should be too.

Medical Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional before making any health decisions. Content reviewed by the HealthyMag Editorial Team.