When ‘Everything Looks Normal’ Hurts: What a New Study Reveals About Dismissive Women’s Health Care

“Your exam is normal.”

For many patients experiencing pelvic or vulvovaginal pain, these words aren’t comforting - they are distressing.

A new study published May 8 in JAMA Network Open offers the first patient-centered instrument to quantify adverse care experiences in vulvovaginal disorders. The findings are staggering:

• 52.8% of patients considered stopping care altogether

• 39.4% said they were made to feel “crazy”—the most distressing behavior reported

• 20.6% were referred to psychiatry without a medical workup

• Patients had seen an average of 5.5 clinicians before reaching a specialist

These experiences align with what some describe as medical gaslighting—a term the authors define as the dismissal of a patient’s genuine concerns without appropriate evaluation, often due to systemic factors like clinician ignorance or bias. But the study’s deeper contribution lies in its framing: this isn’t about pointing fingers. It’s about epistemic injustice—when patients’ knowledge of their own bodies is unfairly dismissed or discredited.

“It’s Not That You’re Not in Pain. We Just Haven’t Found the Cause Yet.”

In an Instagram Live discussing the study, co-authors Dr. Chailee Moss and Dr. Jill Krapf reflected on how they’ve changed their language in clinical practice. One of the most distressing findings from the survey was how invalidating it felt to hear “your exam is normal” when experiencing real pain.

Dr. Moss shared how she now reframes this with patients.

Dr. Krapf added that even as specialists, there are times when exam findings don’t fully explain what a patient is feeling. But that doesn’t mean the pain isn’t there. And it doesn’t mean it’s “all in your head.”

Patients Know When Clinicians Don’t Know

What makes this study so valuable is its patient-centered design. It was built on real patient testimonials and refined with input from advocacy groups like the National Vulvodynia Association and Tight-Lipped.

Importantly, many patients in the study did not assume malicious intent. Instead, they pointed to a root cause: lack of clinician education in vulvovaginal disorders and sexual pain. As Dr. Moss shared that patients knew that the root of a lot of this behavior was lack of training and lack of education.

This helps explain why these experiences are so widespread. It’s not about individual doctors failing. It’s about a system that under-prioritizes women’s pain, under-funds research, and under-trains clinicians.

The Harm Is Measurable

This isn’t just about discomfort. Dismissive or invalidating care can cause measurable harm:

• Delays in diagnosis for conditions like lichen sclerosus or pudendal neuralgia

• Secondary complications like pelvic floor dysfunction from untreated pain

• Emotional trauma that rivals or exceeds the physical symptoms

• Loss of trust in the healthcare system—and in oneself

And yet, patients also reported moments of hope: clinicians who partnered with them, listened without judgment, and acknowledged pain even when answers weren’t clear.

Where Do We Go From Here?

If over half of patients with vulvovaginal disorders are considering walking away from care, we don’t have a bedside manner problem—we have a systemic one.

That means:

• Rebuilding medical education to better cover sexual and pelvic pain

• Training clinicians in communication that validates rather than dismisses

• Funding research into underdiagnosed, poorly understood conditions

• Measuring the impact of interventions using tools like the one developed in this study

As the authors emphasized, it’s not enough to know these problems exist. We need metrics, education, and cultural change to make care better—for patients and for the clinicians who want to help them.

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Because “normal” shouldn’t hurt. And no one should feel alone when they’re trying to get help.