Can a “normal” pelvic exam mask life-altering pain? On this episode of BackTable Women’s Health, host Dr. Karen Toubi interviews board-certified OBGYN Dr. Chailee Moss about why common vulvovaginal pain and skin conditions are frequently missed or dismissed as “normal” exams. Dr. Moss explores how gaps between gynecology and dermatology, limited training, and the under-recognition of non-life-threatening but highly morbid pain contribute to these diagnostic challenges, including mental health impact and even suicidality in some cases.

---

Get the BackTable app
https://www.backtable.com/app

---

Timestamps

00:00 - Introduction
03:56 - Why Pain Gets Missed
08:58 - Building Trust With Time
10:51 - Vulvodynia Workup Basics
16:02 - Hormonal Vestibulodynia Clues
21:21 - New Treatments On Horizon
23:07 - Lichen Steroid Maintenance
26:25 - Biopsy Decisions And Mimics
30:30 - Multimodal Treatment Planning
33:00 - Pelvic Floor PT Done Right
35:55 - When To Consider Surgery
37:33 - Clinical Trials Ketotifen Botox
40:40 - Conclusion and Resources

---

More about this episode

They discuss rebuilding trust through time, attentive listening, and clear communication, along with a detailed evaluation process that includes medication review, targeted symptom questions, Q-tip mapping, vulvoscopy, cultures, and selective biopsy. The approach informs an individualized, multimodal treatment plan. Additional topics include lichen steroid counseling,differentiating mimickers like yeast and irritant dermatitis, and connecting patients to resources such as ISSWSH, ISSVD, and support groups.

---

Resources

Experiences of Care and Gaslighting in Patients With Vulvovaginal Disorders https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2833711

ISSWSH

https://www.isswsh.org/

Pudendal Hope

https://www.pudendalhope.info/

Tight Lipped

https://www.tightlipped.org/

The National Vulvodynia Association

https://www.nva.org/

---

BackTable Women's Health is the go-to podcast for gynecologists, gynecologic surgeons, and other healthcare professionals focused on women’s health.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

► https://www.backtable.com/app