No Reason for Shame

“Is there anything that has made it better?” I asked. I was trying to be a thorough third year medical student by getting through all of OLDCART (an acronym used for pain assessment: Onset; Location; Duration; Character; Aggravating/relieving; Radiation; Timing). I was on “R” for relieving factors. That’s when she starting weeping.

The patient was an older woman who had come looking for solutions after months of suffering. Her chief complaint: a constant, intrusive and undesired feeling of sexual arousal. Ms. S traveled a few hours for this appointment because the doctors she previously visited did not know how to manage her persistent genital arousal disorder.

Persistent genital arousal disorder (PGAD) is rare and women are more commonly affected. It is characterized by symptoms of physiologic sexual arousal without perceived subjective sexual arousal. The feeling of arousal, which can last from hours to days, is undesired, distressing, intrusive, and can be painful. It can occur constantly and typically does not remit. Its etiology is still unknown and treatments for PGAD have had variable success. Patients are often told that there is nothing that can be done to help them.

As ters continued to fall, she confessed, ashamed, that even though it was against her religious beliefs, she masturbated in an effort to make the feeling of arousal disappear. However, the feeling of arousal would not go away and became extremely painful. I held her hand as she cried. Tears started gathering in my eyes but I held them back. I understood why she felt ashamed but I desperately wanted her to know that there was nothing to be ashamed of.

Demographically, we are so different. I am an Asian male in my 20s who has lived most of my life in the city. My parents are immigrants from South Korea. Growing up, I did not talk to many women like Ms. S. Despite our differences, I connected with her more than I had with any other patient. During medical school, I developed chronic pain in my neck and jaw. When it first started, the pain was relentless, sometimes keeping me up at night. I couldn’t eat certain foods that I loved. We had both gone to different healthcare providers to look for answers without success. We both experienced sleepless nights due to constant discomfort.

Pain and suffering are inevitable parts of life. But I had not seen many people suffer like Ms. S. “To me, this is a matter of life and death,” she wept, “I can’t live like this.” In addition to the shame of masturbating to alleviate her symptoms, she was also ashamed because her suffering had driven her to contemplate suicide. I wanted nothing more in that moment than to heal her in some way. However, as we continued to talk, I knew I didn’t have answers. I wasn’t even sure whether my preceptor, who was with another patient, had answers.

I decided my role in that moment was to be compassionate and listen to her. She could see the emotion in my face as I listened. I carefully wrote her story in my History and Physical, turning the computer monitor around so that she could read what I wrote. I thought it was extremely important that I told her story correctly, with the right words and descriptors, since this was such a sensitive subject. If my note could help another provider treat her, I had done my job.

I will never forget my interaction with Ms. S. She encouraged me even in her suffering. “This is your calling,” she stated, “you were meant to be a doctor”. That meant the world to me. It gave me strength to continue to show compassion. Ms. S ultimately influenced my decision to go into Urology. She made me realize that I want to help patients deal with some of the most sensitive or even taboo medical problems. I do not want patients to feel shame because of their conditions.

Caring for Ms. S that day required me to follow my training: get a good history (don’t forget OLDCART), write a thorough and accurate note, and do everything with compassion.