Health Professionals' Approaches to Support Patient Diversity in the Assessment of Vaginismus: A Critical Feminist...

Background/Objectives: Current research on vaginismus predominantly represents White cisgendered and heterosexual women of reproductive age. It is unclear how health professionals (HPs) navigate and support the needs of patients with vaginismus who are gender, sexually, ethnically, religiously, age and/or disability diverse. Therefore, this qualitative study explored health professionals' experiences and perceptions of patient diversity to holistically assess and support people with vaginismus. Methods: In 2023-2024, 23 HPs in general practice, uro/gynaecology, pelvic floor physiotherapy, mental health, nursing and clinical education participated in semi-structured interviews. Data were inductively thematically analysed with a critical feminist poststructuralist focus on heteronormativity, cisnormativity, ethnocentricity, chrononormativity, and able-bodied normativity. Results: Two themes were developed. The first theme on 'uneven attention of diversity dimensions in the assessment and support of vaginismus' explored patients' ethnicity, religion, sexuality, gender, age and disability. The second theme on 'sexually and gender-diverse people's varied treatment goals for vaginismus' examined nuanced challenges between heterosexual and non-heterosexual women and limited representation of gender-diverse people. Conclusions: The findings suggest that not discussing patients' diversity may contribute to their identity erasure and ethnocentric exaltation of White centrality. Treatment approaches may uphold heteronormativity. HPs often described vaginismus as a young woman's problem. It is recommended that HPs review whether patients with advancing age and/or disability suppress desires for pain-free sex due to societal norms. Decolonising approaches and abject theory could inform the development of inclusive health resources. This can assist HPs to sensitively and supportively assess patients' diversity to improve their holistic health and well-being outcomes for vaginismus.