"Having Pain is Normal": How Talk about Chronic Pelvic and Genital Pain Reflects Messages from Menarche.

Chronic pelvic and genital pain conditions (CPGPCs) often go undiagnosed and untreated in women for years after symptom onset. This is due, in part, to communication challenges experienced by patients such as difficulties describing pain and the stigmatized nature of CPGPCs. However, studies have yet to explore how early messages about menstruation, a context similar in its stigmatized and painful nature, may contribute to undertreatment and diagnostic delays for adult women experiencing CPGPCs by normalizing pelvic and genital pain when they are young girls. Guided by critical feminist theorizing (CFT) and sensitized by an existing typology of negative messages communicated by mothers to daughters about menstruation, this study analyzes interviews with 17 women with CPGPCs to explore how features of negative messages about menstruation (i.e., information restriction and omission) appear and recur in women's descriptions of their later CPGP experiences. Findings suggest that early life talk about menstruation forms a communicative precedent for young girls which later constrains how they talk about CPGP in adulthood. Findings also problematize early-life communication about menstruation, which normalizes women's pain, and suggest connections to outcomes (e.g., diagnostic delays) for women with CPGPCs. Theoretical and practical implications are offered. Limitations and future directions are described.

Communication Work About Chronic Unexplained Pain.

This essay draws upon Donovan's conceptualization of "communication as work" to explicate types of communicative work undertaken by the authors - two patients with vulvodynia, a poorly understood chronic genital pain condition - during patient-provider interactions prior to diagnosis. Uniquely positioned as patients-turned-scholars, we extend the rich construct of "communication work" by narrating the types of communicative work undertaken ourselves as patients communicating within a stigmatized health context for which a clear diagnosis is often ambiguous or unable to be reached. Donovan notes that conditions with a high degree of uncertainty and ambiguity have the capacity to shift the nature of talk. This brief essay illustrates the ways in which the nature of patient-provider communication work is shifted by the ambiguity of this health context. Theoretical and practical implications are briefly offered.