Abstract
Background:
Dyspareunia (pain during sex) is a common condition that causes physical and emotional stress for many women. This condition can be caused by various factors, including physical, hormonal, inflammatory, viral, neoplastic, psychological, and traumatic events. Anatomical causes include pelvic floor muscular weakness, uterine retroversion, hymenal remnants, and pelvic organ prolapse. The etiology of this condition is complex, causing it to be often overlooked.
Objectives:
The main aim of this study was to conduct a qualitative exploratory study and provide a comprehensive description of the knowledge and attitudes held by gynecologists in Kazakhstan on the medical validity, diagnosis, and treatment of dyspareunia.
Design:
This is an exploratory-descriptive qualitative study.
Methods:
Semi-structured online interviews were conducted with 10 physicians. They were identified as obstetrics and gynecology specialists, gynecologic oncologists, and outpatient gynecologists. The average number of years spent practicing their specialty is 15.7, with the shortest being 4 years and the longest being 35 years. All the participants are female. Braun and Clarke’s six-stage, step-by-step methodology was used for the thematic analysis.
Results:
Findings suggest that gynecologists in Kazakhstan have knowledge of the most common causes of dyspareunia, although they still often attribute women’s distress to psychological rather than physical factors. It was found that due to stigma and mutual embarrassment open dialogue about sexual health was lacking between patients and physicians. In addition, gynecologists describe difficulties discussing symptoms and performing intimate examinations due to time constraints and a lack of privacy at state facilities.
Conclusion:
To knowledgeably diagnose and treat patients with dyspareunia, gynecologists recommend further training to acquire the requisite evidence-based knowledge and competencies.
Plain Language Summary
Background: Dyspareunia (pain during sex) is a common condition that causes physical and emotional distress in many women. Biological and psychological factors contribute to the onset of this condition, making diagnosis and management difficult for physicians. This painful condition can have a significant impact on women’s physical, emotional, and psychological well-being, as well as their close relationships. Why was the study conducted? A thorough understanding of dyspareunia’s causes, risk factors, and treatment techniques is required for effective management of the condition, but little research has been conducted in Kazakhstan on gynecologists’ understanding of and attitudes toward dyspareunia. What did the researchers do? A qualitative study used online semi-structured interviews with gynecologists in Kazakhstan. What did the researchers find? The findings show that participating gynecologists are aware of the most common causes of dyspareunia, although they frequently attribute the condition to psychological rather than physical causes. It was found that due to stigma and mutual embarrassment, patients and participants did not engage in open discourse about sexual health. Furthermore, gynecologists have difficulty initiating discussions about women’s sexual health and performing intimate examinations due to consultation time restrictions and a lack of privacy at state facilities. What do the researchers conclude? Additional training is recommended to gain the necessary evidence-based knowledge and competencies to accurately diagnose and treat patients with dyspareunia, and to address the lack of treatment protocols for dyspareunia in Kazakhstan, clinical guidelines published worldwide, including those issued by the American College of Obstetricians and Gynaecologists, may be considered for use in Kazakhstan.
Keywords
Introduction
Dyspareunia, a condition characterized by recurrent genital pain during sexual intercourse, affects a significant portion of the population, particularly women. 1 In their work, Tayyeb and Gupta 1 state dyspareunia has a worldwide prevalence ranging from 3% to 18%, and it can impact 10% to 28% of the population in their lifetime. They go on to describe dyspareunia as a “complex condition that is frequently ignored” 2 (page 1). This distressing condition can have a profound impact on an individual’s physical, emotional, and psychological well-being, as well as on their intimate relationships. 3
Biological and psychological components are among the many that contribute to the onset of this condition, making diagnosis and management challenging and difficult for both patients and professionals. 1 A comprehensive knowledge of dyspareunia’s causes, risk factors, and treatment techniques is essential for efficient management of the condition.
As such, the primary goal of this study is to qualitatively explore and describe Kazakhstani Gynecologists’ knowledge and attitudes toward the medical legitimacy, diagnosis, and management of dyspareunia.
To our knowledge, no dyspareunia research conducted in Kazakhstan, a post-Soviet Central Asian country, has been published in peer-reviewed journals, and we must be cautious of extrapolating findings from other societies and applying them universally to Central Asian countries, which is why the setting of this study is so important. Kazakhstan suffered numerous economic, political, and social difficulties as a result of the collapse of the Soviet Union. The Soviet Union offered universal health care and established a variety of policies and practices that improved the quality of life of the population and promoted gender equality, but after independence, these policies and practices disappeared or fell substantially. 4 Recent reforms in health care and increased public health research have improved the population’s health in Kazakhstan compared with the years immediately after independence, despite the persistence of various health concerns. 5 Therefore, it is crucial to acknowledge the existing state of care delivery and to place an emphasis on women’s health, particularly on providing them with access to health care that is backed by solid evidence-based research.
Facchin et al. 6 reviewed 17 qualitative research articles to learn more about women’s experiences with dyspareunia (how they perceive and describe their pain, how they deal with it, and how it impacts their mental health and relationships with others). Dyspareunia was described by women with endometriosis to occur at climax, during, and/or after sexual activity, and to be deep, introital, and/or positional. Based on their findings, Facchin et al. 6 concluded that dyspareunia has a negative impact on women’s mental health, specifically in the areas of low self-esteem, a weakened feeling of femininity, and interpersonal ties. They also point to the general reluctance of both women and clinicians to discuss sexual health issues openly.
Recognizing the role that health care practitioners, such as gynecologists, can play, Pettersson and Berterö 7 conducted a meta-analysis of women with endometriosis’ health care experiences, including dyspareunia symptoms. The meta-analysis was based on 14 articles published between 2000 and 2018. They included 370 women with endometriosis ranging in age from 16 to 78. According to the meta-analysis, endometriosis patients who obtain non-specialist care believe their concerns are not taken seriously by medical personnel. Among other noteworthy findings, the meta-analysis indicated that women believed clinicians dismissed their discomfort as menstrual pain and, as such, as something natural and fundamental to being a woman, which all women experience. The authors conclude that their meta-analysis demonstrates that improved knowledge and attitudes among health care personnel may improve the quality of life for women with endometriosis.
While there is a general paucity of research on dyspareunia, Kazakhstan is especially deficient in this area. Our literature review uncovered only one study, Khalmanova’s 8 master’s thesis, which studied nurses’ and midwives’ awareness of female pelvic floor disorders in Kazakhstan. This study briefly highlighted dyspareunia, along with ignorance of pelvic or reproductive system diseases, as one of the causes contributing to Kazakhstani women’s low levels of sex activity.
This exploratory-descriptive qualitative (EDQ) study aims to address the lack of research on the condition in general and in Kazakhstan in particular by exploring and describing the knowledge and attitudes of Kazakhstani Gynecologists toward the medical legitimacy, diagnosis, and treatment of dyspareunia.
Methods
Study design
This study used an EDQ design, which is a research design that aims to describe phenomena by exploring them from the participants’ perspective. 9 EDQ has been recognized as a useful theoretical framework for investigating under-researched facets of health care delivery. 9 The design was appropriate for this study because it allowed the researchers to explore the perspectives of gynecologists in Kazakhstan who are involved in the diagnosis and management of dyspareunia, as well as generate information for future research and potentially inform and create insights into the changes that are required in Kazakh gynecological practice.
Sample size and recruitment strategy
Purposive sampling was used to recruit certified gynecologists from across Kazakhstan’s several gynecological subspecialties once we received approval from the institutional review board (IRB). The researchers’ personal contacts allowed them to accomplish this. Using this group as a starting point, snowball sampling method was used next to locate and enroll additional participants. Participants were required to be active gynecologists with a medical degree and licensure in Kazakhstan. Despite the identification of 13 eligible participants, the final sample size was established using data saturation. 9 As a result, 10 semi-structured interviews were conducted.
Research team
The research team consists of a British Assistant Professor of Behavioural Medicine, a Kazakh PhD candidate who speaks Russian and Kazakh and is a registered physician, and a third member who conducted the interviews who is a Kazakh national with extensive experience conducting qualitative interviews. Everyone on the team contributed to the analysis. All members of the team are female.
Data collection
Using a semi-structured interview guide (see Table 1), the interviewer asked open-ended questions to participants in a manner that allowed them to generate their own descriptions which meant that the same topics were discussed with multiple interviewees, but the interviews unfolded differently.
Example interview guide.
The interview guide’s content was initially developed through a combination of brainstorming sessions and reviews of the available research. Once agreed upon, it was translated into Russian and Kazakh and piloted with a single participant. The pilot interview’s transcript was verified by the research team and incorporated into the final analysis.
Each interview was conducted online and consensually visually documented. After every interview, the audio data were transcribed, and the original recordings were deleted. Each transcription was given a study code, consistent within the research team and throughout the study, and all identifiers were removed from the transcripts. The procedures put in place to protect the confidentiality of the data included restricting access to these files to only principal investigators.
An informed consent procedure took place. Each participant provided written informed consent before any data were collected, and participation was entirely voluntary. The researcher assured everyone involved that they might leave at any time without any repercussions. Interviews were conducted from January to March 2022. Each interview lasted from 90 to 180 min and was scheduled at the participant’s convenience. The interviewer also recorded her observations in the form of reflective notes.
The interviewer prepared transcripts. The interviews were initially transcribed in Russian or Kazakh depending on the language spoken by the participant and then translated into English. To ensure the study’s rigor, consensus coding was undertaken with researchers coding the same transcripts and comparing the results on a one-to-one basis. The analysis and selection of the main and subthemes were done collaboratively.
Data analysis
Thematic analysis, using the six-stage, step-by-step methodology of Braun and Clarke (Figure 1), 10 was selected as the method of data analysis for this EDQ study. Thematic analysis is well-suited to the primary goal of exploratory data synthesis (EDQ), which is to characterize and understand participants’ experiences in connection to the phenomena under investigation. In addition, previous research with similar designs has shown that thematic analysis is effective. 11
A flow diagram depicting each step taken in the study.
Results
Ten gynecologists from state and private clinics participated in the study, self-identifying as gynecologist, obstetrics and gynecology, outpatient gynecologist, and gynecologic oncologists. Mean years of practice is 15.7 with 4 years as being the least time practicing and 35 years being the longest. All participants were female.
As shown in Table 2, three main themes and subthemes were identified.
Themes and subthemes of participants’ data with representative quotes.
Theme 1: dyspareunia: a difficult symptom in gynecological practice
Participants described dyspareunia as a highly complicated condition that is difficult to diagnose and treat. For example, they explain that determining a precise etiology is difficult, and there is some debate over whether this condition is better classified as a physical disorder or a psychosomatic disorder. They stressed the importance of correctly establishing the source of the problem to choose the appropriate treatment method for their patients.
With regard to their understanding of the factors that lead to dyspareunia, the majority of participants had a high level of confidence in their knowledge. Participants noted a wide variety of variables, including structural, inflammatory, infectious, neoplastic, traumatic, hormonal, and psychological, as contributing to the onset of the condition, for example, “in my practice, this occurred after radiation therapy, when a woman has sclerosis or from thickening of the walls of the vagina,” (participant 10) and “there can be many reasons, such as different types of endometriosis, myxomatous nodes, inflammatory diseases, and of course, like many diseases, are associated with psychological experiences” (participant 1). The one exception was a participant who made the following statement: “To be honest, I only heard the term from you, I did not know about it” (participant 4).
Theme 1.1: psychosomatic condition
It is interesting that despite being aware of potential causes such as physical issues, infections, and illnesses, the majority of participants identified psychological issues as the most significant predictor of dyspareunia:
First of all, as a doctor, I believe that the root of any disease is psychosomatics when a woman cannot establish a connection with her partner, and she does not perceive him. And, accordingly, the psychosomatics of their sexual life is not well established. And they suffer from diseases of the pelvic organs. As a doctor, I always put psychosomatics ahead. (Participant 9)
Theme 1.2: medical legitimacy
Given the emphasis placed on psychological factors as the probable cause, we were interested in discovering whether or not gynecologists considered dyspareunia to be a significant issue, as well as whether or not treatment was within their scope of practice. Opinions were mixed among our participants. Dyspareunia was believed by some to be a valid medical condition, while others were not so sure:
. . . Yes, this should be given special serious attention. This is my opinion. As a gynecologist, I think that this is serious and can have serious consequences. They affect mental, and physical health and will affect family life . . . (Participant 1) We didn’t even go through that at university . . . many of my colleagues also do not know and do not take it seriously, which means they will not treat it. (Participant 2)
Theme 2: neglected condition
The concept of dyspareunia as a neglected condition is evident in participants’ descriptions of how sexual dysfunction in women has been and continues to be overlooked in clinical consultations.
The majority of participants stated that it is their responsibility to discuss sexual issues with their patients. However, they confess that they, and to their belief, very few other physicians have such conversations. They highlighted that there are a variety of barriers to these conversations taking place in routine practice, including a lack of clinical time to address the psychological, social, and sexual components of the patient’s illness. Moreover, participants say that they consider patients’ sexual life as too personal to ask about:
. . . This pathology is hushed up not by its absence, but by the fact that it is not customary for us to deal with this problem. And we don’t have statistics, because women simply don’t talk about it, they are ashamed to talk about problems in their sexual life. (Participant 8)
Participants were certain that no effort was being made to collect epidemiology data on dyspareunia among women in Kazakhstan. Mostly, they believed that this was a mistake as more data lead to more recognition and maybe a larger emphasis on treatment and legitimacy, which is worth noting, as they themselves were undecided upon the medical legitimacy of dyspareunia:
If some statistics are kept in other countries, then in Kazakhstan they are not, and therefore no one knows, and I think that it is important to raise this topic and at least somehow identify the statistics and understand the percentage of existing pathologies, at least to know the statistics, these matters and worth to say that it relevant to Kazakhstan. (Participant 7)
Theme 2.1: restrictive conditions in state clinics
Although there are for-profit clinics that are privately owned, “state” health care institutions in Kazakhstan are owned and operated by the public sector, represented by the Ministry of Health. Participants expressed concerns about the restrictive conditions in state facilities, citing time constraints as a major reason why, in addition to their cultural aversion to discussing sexual issues, a sexual history is only taken on occasion (during screening appointments), and a lack of privacy as another reason why sexual dysfunction in women has been and continues to be under-addressed in clinical consultations:
. . . Ask more about pain during intercourse, I, as a gynecologist, would like to ask. But it is difficult, there is simply no time to talk about it in state clinics. So, the problem here is not that this pathology is absent in our women, just an elementary lack of time and lack of conditions. (Participant 7) Of course, if we talk about gynecologists in a private clinic, then to make their appointment more complete and of high quality, they can devote more time, and a doctor in a state clinic will not do this and waste his time on this, they will simply not even ask these questions and be interested in the quality of a woman’s sexual life, knowing that she has neither the time nor the incentive. (Participant 5)
Theme 2.2: benign neglect in medical education and reluctance to change
Participants highlighted the current gap in undergraduate and graduate education regarding the topic female sexual health, “I am not afraid to say that the level of awareness in this area among doctors in Kazakhstan is low, roughly speaking, 50% of our doctors have not deeply studied this topic” (participant 3) and “I have never met in my practice a single seminar, conference, or lecture, no training on this topic” (participant 5).
Participants spoke of how dyspareunia should be recognized and treated more successfully in Kazakhstan; nonetheless, they all agreed that doctors in Kazakhstan aren’t very motivated to make improvements, as evidenced by the following quote “Our doctors seem to be not motivated for further development, many are satisfied with everything, and no one wants to change anything” (participant 7).
Theme 3: women’s reluctance to seek treatment
Participants were mindful of the fact that many women do not inform their gynecologists about the condition, even though it might cause a lot of pain. As one participant put it, “This pathology exists among us quite often, but women are silent and do not speak, perhaps even because they do not know what to say.”
According to the participants, the most common reason for failure to diagnose the condition is women’s reluctance to seek therapy for example, “We often hear from women that many of them did not attach importance and did not take it seriously” (participant 6). Women’s lack of interest is attributed to their “ignorance” as well as their embarrassment, for example, one participant stated, “in the beginning, a woman does not take all of this seriously and is embarrassed to speak or does not know what to say” (participant 5).
Theme 3.1: shame and humiliation
The embarrassment experience by their patients was referred to as “the habit of silence” or “Kazakh” feelings of shame and humiliation. Participants explained that among the practices that manage gender and sexuality within families and wider groups, the culture of shame, which is also known as “uyat,” is as one of the most significant practices to preserve the “traditional” order that has been established in the country:
. . . The Kazakh mentality teaches them to be silent and until illness hits them on the head. But the main thing is that first of all, it is a shame to discuss problems and pains, especially sexual life, and the rest simply consider pain as the norm. (Participant 1)
Participants acknowledged their patients’ shame and embarrassment, as well as their own embarrassment in initiating conversations regarding sexual difficulties with their patients and stated that they preferred to focus on more “objective” clinical criteria, for example, focus on the physical components of care.
Participants also described strategies for avoiding or limiting sexual health conversations to a level that is comfortable to them. Some cited being from an older Kazakh generation that avoided addressing sexuality as one of the obstacles to overcome. Cultural and gender issues significantly influenced participants’ perceptions. Many of their perspectives on sexual health were bound to gender traits, and because the female gender is associated with emotions women’s sexual dysfunction is considered as a “psychosomatic” problem.
When asked about ways to address the shame culture, participants most frequently mentioned the implementation of an early sexual education program into the curriculum of schools as the technique that would be most effective. In their opinion, something of this nature has the potential to assist in normalizing women’s sexual health and reducing the feelings of shame and humiliation that are connected with it:
I think you need to start early. That is, to introduce gradual sexual education from preschool age and continue at school and have a permanent lesson in sexual education so that at any age it would not be embarrassing to talk about it and not hide it. (Participant 2)
Discussion
As far as we can discern, this is the first in-depth qualitative study to explore and describe Kazakhstani gynecologists’ understanding of, and approach to, dyspareunia in terms of its medical legitimacy, diagnosis, and management.
Despite limited epidemiological data, participants believe dyspareunia is a common condition in Kazakhstan. With the exception of one gynecologist, all participants believe they understand dyspareunia, its causes, and how it impacts women emotionally and physically. Surprisingly, despite their assertions of professional knowledge, we can perhaps infer a gap in their “evidence-based” understanding of dyspareunia from their tendency to attribute the cause of dyspareunia to psychological rather than physical issues, which differs from the conventional medical view that dyspareunia could be attributed to an organic and/or psychological cause or be idiopathic.1,12
The primary reason attributed to physicians’ failure to diagnose dyspareunia was women’s lack of interest in reporting and discussing symptoms. Given that participants had different opinions on the medical validity of dyspareunia, this raises the intriguing topic of how physicians’ views on legitimacy impact women’s willingness to talk to them about sexual dysfunction. There needs to be further research into this, but Braksmajer 13 discovered in a qualitative study on women’s struggles for medical legitimacy when dealing with sexual pain, that when physicians didn’t diagnose, women felt their body-awareness was ignored and their symptoms were blamed on psychological factors. Braksmajer further found that women identified a link between their experiences of invalidation and gender bias.
In consideration of our finding of a difference in opinion on the medical legitimacy of dyspareunia, context may be relevant. In Kazakhstan, there are no treatment protocols for dyspareunia. This lack of therapeutic guidelines may lead gynecologists to question the medical legitimacy of the condition. Instead, management of dyspareunia is approached as part of the clinical manifestation of urinary or sexually transmitted infections, inflammatory gynecological conditions, and endometriosis.14 –17 Thus, according to local clinical practice, dyspareunia is not a condition but rather a symptom of another disease. Gynecologists who treat women with dyspareunia must rely on their professional experience and judgment to manage the problem in the absence of inflammatory or infectious infections.
Participants’ description of dyspareunia as a “neglected condition” in Kazakhstan is partially supported by their explanation that they do not regularly initiate sexual health conversations with patients due to time constraints, a lack of privacy in state facilities, and the stigma and embarrassment associated with discussing women’s sexual health. Interestingly, the stigma and embarrassment in our study were bidirectional, with gynecologists expressing reluctance to encourage patients to discuss sexual health due to their own discomfort and/or unwillingness to exacerbate female patients’ embarrassment. The conversation of dyspareunia tends to be challenging for both the patient and the doctor. Similar findings were reported by Facchin et al. 6
Once again context may help, the “uyat” culture of Kazakhstan, as mentioned in the results, regulates gender and sexuality within families and larger communities. 18 The word Uyat translates as “shame” but refers to an entire system of values and represents a long tradition of acceptable moral-ethical behavior in Kazakh society.
Kazakh children are exposed to gender stereotypes and “uyat” culture-promoting messages about modesty, discretion, and proper female behaviors from an early age. Local government endeavors also reflect or affect these assumptions; for instance, Kabatova 19 reports that in 2017, the Akimat of Astana City (the mayor’s office) and the Office of Youth Policy of Astana hosted a lecture entitled “Moral Upbringing of Ladies.” Because of cultural, religious, and traditional perspectives, sexual behaviors are a contentious (18) and understudied subject in Kazakhstan.
Our findings indicate that the stigma associated with dyspareunia and its repercussions on physical and psychological health are hurdles that may result in diagnostic delays (i.e., the delayed time between the onset of symptoms and diagnosis or treatment). Similarly, Seear et al. 20 conducted a qualitative study in Australia to assess the experiences of endometriosis patients. According to the authors, endometriosis stigma and its detrimental effects on physical and psychological well-being are exacerbated by a lack of understanding among women, their families, intimate partners, medical professionals, and the general public. Furthermore, they claimed that the stigma associated with endometriosis is a significant issue that contributes to diagnostic delay.
A number of suggestions for improvement were made by our participants. They first recognize the need for greater education and training for professionals to appropriately diagnose and treat dyspareunia. They also agree on the need and necessity of incorporating an early sexual education program into the school curriculum on a regular basis to normalize female sexual health. Sexuality is currently a societal taboo in Kazakhstan, and the school curriculum does not teach sexual and reproductive health and rights.21,22
Our participants also stressed the importance of enhancing the doctor visit experience in state polyclinics as a secondary criterion. They advocated for longer consultation times and, more crucially, a culture of privacy, so that patients and physicians can have private conversations about sexual health and perform intimate examinations, a service that is often taken for granted in Western Institutions. 23
Strengths and limitations
This is the first known study to qualitatively explore the knowledge and attitudes of Kazakhstani gynecologists toward Dyspareunia. The use of qualitative methodology facilitated the identification of factors that cannot easily be ascertained or described through quantitative means.
The main strength of this study is that the findings shed light on the reasons behind the influence of certain circumstances on the efficacy of gynecologists, as well as viewpoints on the fundamental causes of dyspareunia underdiagnosis in Kazakhstan.
This study has several limitations. First, we acknowledge that 10 interviews are a relatively small sample size. However, given the exploratory nature of the study and the methods employed, a relatively low number of interviews was deemed adequate, given the breadth and depth of the interviewee’s knowledge of the topic at hand. Sample size was also calculated based on the degree of data saturation. 9
Second, because of the lack of face-to-face interaction, communication may have suffered in online interviews; however, a recent study, Saarijärvi M and Bratt EL concluded qualitative interviews performed through video are valid and trustworthy alternatives to traditional face-to-face interviews. However, rapport between interviewer and interviewee may be lower than in-person, and it may be more challenging to pick up on nonverbal clues, especially visual ones.
Third, we should mention the limited transferability. Our results are context specific to Kazakhstan who is historical, political, economic, cultural, and health care settings differ significantly from those in the west. Provision of the complete description of the study process and a description of the study context conceivably added to the transferability of the study within Kazakhstan.
Finally, questions of reflexivity need to be considered. One member of the analytical team is a White British woman who doesn’t speak Russian or Kazakh, which may have affected her assumptions and maybe even her relationships with the Kazakh natives who make up the rest of the team. The fact that two of the analytic team members are doctors and another is an assistant professor of behavioral medicine may have affected their critical thinking when reading and analyzing the transcripts. All members of the team, however, are experienced qualitative researchers who acknowledge their personal history, assumptions, and worldview will influence the research process.
Recommendations
Dyspareunia in Kazakhstan has received little attention in the research arena; therefore, we recommend that additional research be conducted, on dyspareunia-related stigma in the context of Kazakhstan along with other cultural groups with “sex-negative” attitudes.
Although research in this area is limited, it may be speculated that relatively restrictive, “sex-negative” attitudes in a cultural group would be less conducive to effective help-seeking. 25
The implementation of dyspareunia awareness programs would be a step in the right direction. Population-wide and health system-wide awareness campaigns would provide a safe atmosphere for education and healthy dialogue between those living with dyspareunia and associated conditions such as endometriosis, and their families, intimate partners, and health care professionals.
Our research indicates that gynecologists themselves believe they require better training. The bidirectional embarrassment indicates ineffective communication between patients and their gynecologists, demonstrating the need for additional knowledge regarding dyspareunia and training for gynecologists on how to interact more effectively with their patients.
In addition, finally, clinical guidelines published worldwide, including those issued by the American College of Obstetricians and Gynaecologists (ACOG), may be considered for use in Kazakhstan. 26 The ACOG recommendations for dyspareunia suggest a multidisciplinary approach to treating the physical, emotional, and behavioral aspects of pain. This plan should include a gynecologist, urologist, psychiatrist, pain management specialist, physical therapist, and mental health practitioners who specialize in chronic pain.
Conclusion
Major findings from our study of Kazakhstani gynecologists’ understanding of and attitudes toward dyspareunia are as follows: Despite a solid understanding of the common physical causes of dyspareunia, many gynecologists in Kazakhstan still attribute women’s pain to psychosomatic factors. It was shown that the main reasons for an under diagnosis of dyspareunia are that gynecologists and patients in Kazakhstan do not regularly discuss sexual health due to stigma and mutual embarrassment. Second, patients and gynecologists were unable to have confidential conversations about sexual health and perform sexual examinations because of the lack of privacy in state facilities.
All respondents agree that clinicians need more information and training to properly diagnose and treat individuals with dyspareunia. In addition, that conditions in state clinics need substantial improve with regard to privacy for woman.
Supplemental Material
sj-docx-1-whe-10.1177_17455057241259169 – Supplemental material for “The habit of keeping silent”: An exploratory-descriptive qualitative study of the knowledge and attitudes of Kazakhstani gynecologists toward dyspareunia
Supplemental material, sj-docx-1-whe-10.1177_17455057241259169 for “The habit of keeping silent”: An exploratory-descriptive qualitative study of the knowledge and attitudes of Kazakhstani gynecologists toward dyspareunia by Faye Foster, Aigerim Mendygali and Dinara Makhadiyeva in Women’s Health
Footnotes
References
Supplementary Material
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