Abstract
Study Objective
To investigate specialist clinicians' experiences of treating vaginal agenesis.
Design
Semi-structured interviews.
Setting
Twelve hospitals in Britain and Sweden.
Participants
Thirty-two health professionals connected to multidisciplinary teams (MDTs) including
medical specialists and psychologists.
Interventions and Main Outcome Measures
Theoretical thematic analysis of recorded verbatim data.
Results
The gynecologist and psychologist interviewees share certain observations including
the importance of psychological readiness for and appropriate timing of treatment.
Three overlapping themes are identified in our theoretical analysis of the MDT clinicians'
talk: (1) the stigma of vaginal agenesis and the pressure to be “normal” can lead
patients to minimize the time, effort, physical discomfort, and emotional cost inherent
in treatment. (2) Under pressure, treatment might be presented to patients with insufficient
attention to the potential psychological effect of the language used. Furthermore,
the opportunity to question what is “normal” in sex is generally not taken up. It
can be challenging to help the women to transcend their medicalized experiences to
come to experiencing their bodies as sexual and enjoyable. (3) The reality of treatment
demands, which are not always adequately processed before treatment, can lead to discontinuation
and even disengagement with services.
Conclusion
The MDT clinicians in this study emphasized the importance of psychological input
in vaginal construction. However, such input should proactively question social norms
about how women's genitalia should appear and function. Furthermore, rather than steering
patients (back) to treatment, the entire MDT could more explicitly question social
norms and help the women to do the same. By shifting the definition of success from
anatomy to personal agency, the clinical focus is transformed from treatment to women.
Key Words
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Article info
Publication history
Published online: January 12, 2018
Footnotes
The authors indicate no conflicts of interest.
Identification
Copyright
© 2018 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc.
