Patient Perspectives Support Trauma-Informed, Integrative Care Approaches for Addressing the Psychosocial Side Effects of Chronic Pelvic Pain

Background and Purpose: Chronic pelvic pain (CPP) is a medically unexplained gynecological condition highly comorbid with mental health challenges and correlated with sexual trauma exposure among women. Longstanding concerns about low rates of positive treatment outcomes underscores the need for a deeper understanding of the complex relationships between CPP, trauma, and the broader psychosocial context of patient’s lives in order to develop effective, trauma-informed, integrated care approaches. We address this need through a qualitative analysis highlighting the perspectives of female-identified CPP patients. We explore patients’ views on how CPP negatively impacts multiple psychosocial domains of well-being, as well as their experiences receiving CPP-focused care. Implications for health social workers are discussed.

Methods: We conducted a secondary qualitative analysis of semi-structured group and individual interviews with self-identified female patients about their experiences living with and being treated for CPP. Patients receiving treatment for CPP at the study’s home institution were recruited via telephone. Twenty-nine patients (mean age=40) participated in individual interviews (English=26; Spanish=3), and 19 participated in three separate group interviews (English=2; Spanish=1). The majority (54%) of patients were Hispanic/Latina (26% White; 4% Black; 4% American Indian/Alaska Native; 2% Asian; 2% Native Hawaiian/Pacific Islander; 7% Unknown/Not Reported), completed some college-level education (72%), and had mental health comorbidities (77% anxiety; 66% depression). Forty-seven percent reported 4+ experiences of childhood adversity, including childhood sexual trauma (43%). Spanish transcripts were professionally translated and all transcripts were professionally transcribed. Interview findings were analyzed in NVivo software in accordance with the principles of thematic analysis, an ideal method for generating results meant to inform systemic changes, such as treatment recommendations.

Results: We identified 5 main themes from our findings: 1) Relationships and Social Support; 2) Impact on Mental Health; 3) History of Sexual Trauma; 4) Hope; and 5) Support for Collaborative, Integrated Approaches. Patients described how CPP negatively impacted their entire support system and relational lives across domains, including their intimate partnerships, quality of their sexual lives, and parenting styles, while emphasizing the benefits of supportive relationships. In addition to mental health comorbidities, many patients were impacted by minority stress, describing how language differences and some cultural beliefs and attitudes could serve as barriers to effective CPP care. Patients with previous exposure to sexual trauma expressed how experiencing pelvic pain and undergoing CPP treatment could activate a sense of re-traumatization. Positive attitudes towards treatment options appeared to increase patients’ sense of hope. Patients viewed integrated care approaches for CPP favorably, describing how it helped them understand connections between their physical and mental health in relation to CPP.

Implications and Conclusions: Our findings provide novel insights into the burden of CPP-related minority stress, as well as the salient contribution of hope on CPP patient’s well-being. Social workers can play a key role within interdisciplinary health care teams by facilitating culturally responsive methods for communicating about CPP among diverse communities, working with medical providers to reduce the risk of sexual re-traumatization in standard care procedures, and engaging CPP patients in psychosocial interventions addressing multiple domains of wellbeing.