Sexual Medicine and Medical Collaboration · Pelvic Conditions

The Pain History Nobody Took

Twelve questions on the shelf and you may ask six. Each one you spend gives you her actual answer, and when the budget is gone you see what the questions you skipped would have told you.

What this exercise practises

Taking a pain history under the constraint of a real session, separating questions about the pain from questions about the relationship, and deciding what happens to a couples contract when the pain history changes the formulation.

Six of the twelve are high yield and six are not. The low-yield six are mostly the questions a couples assessment opens with, which is why they are on the shelf.

Estimated time to complete this exercise: 22 minutes

1The history
2The verdict
3No diagnosis
4Close

Before you begin

How this one works

Twelve questions on the shelf. You may ask six. Each one you ask gives you the client's actual answer.
Six of the twelve are high yield for this presentation and six are not. The ones that are not are mostly the questions a couples assessment would open with.
When your six are spent you will see what the other six would have told you, and then you decide what happens to the couples work.
Nothing is graded and nothing is recorded. Reloading starts it again.

A detailed pain history, including the timing of pain relative to the menstrual cycle and specific sexual activities, is essential in any AFAB client presenting with dyspareunia. The budget exists because a first session is finite, and because the questions you spend it on decide what you are able to conclude.

References

  1. ESHRE Guideline Group. (2022). ESHRE guideline: Endometriosis. Human Reproduction Open, 2022(2), hoac009. https://doi.org/10.1093/hropen/hoac009
  2. Gordts, S., Koninckx, P., & Brosens, I. (2018). Pathogenesis of deep endometriosis. Fertility and Sterility, 108(6), 872–885. https://doi.org/10.1016/j.fertnstert.2017.08.036
  3. Latthe, P., Latthe, M., Say, L., Gülmezoglu, M., & Khan, K. S. (2006). WHO systematic review of prevalence of chronic pelvic pain: A neglected reproductive health morbidity. BMC Public Health, 6, 177. https://doi.org/10.1186/1471-2458-6-177
  4. Nnoaham, K. E., Hummelshoj, L., Webster, P., d'Hooghe, T., de Cicco Nardone, F., de Cicco Nardone, C., Jenkinson, C., Kennedy, S. H., & Zondervan, K. T. (2011). Impact of endometriosis on quality of life and work productivity: A multicenter study across ten countries. Fertility and Sterility, 96(2), 366–373. https://doi.org/10.1016/j.fertnstert.2011.05.090
  5. Shifren, J. L., Monz, B. U., Russo, P. A., Segreti, A., & Johannes, C. B. (2008). Sexual problems and distress in United States women: Prevalence and correlates. Obstetrics & Gynecology, 112(5), 970–978. https://doi.org/10.1097/AOG.0b013e3181898cdb
  6. Zondervan, K. T., Becker, C. M., & Missmer, S. A. (2020). Endometriosis. New England Journal of Medicine, 382(13), 1244–1256. https://doi.org/10.1056/NEJMra1810764