"The habit of keeping silent": An exploratory-descriptive qualitative study of the knowledge and attitudes of Kazakhstani gynecologists toward dyspareunia.

Abstract

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. 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. This is an exploratory-descriptive qualitative study. 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. 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. To knowledgeably diagnose and treat patients with dyspareunia, gynecologists recommend further training to acquire the requisite evidence-based knowledge and competencies.