Physicians have historically dismissed women's sexual and reproductive health. Could Cornell's actions, or lack thereof, be making matters worse?

September 23, 2023

GUEST ROOM | The Disturbing Failures in Gynecological Care at Cornell Health

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I graduated from Cornell in 2019. I write to share my personal experiences at Cornell Health because, despite widespread recognition of the need, Cornell Health still does not have a single M.D. gynecologist. In February 2023, The Cornell Daily Sun described President Pollack’s lack of support for hiring a gynecologist. Her statement that it is within the ability of current providers to “diagnose and treat the most common gynecological issues” is simply not true. I write from personal experience to describe how deeply misinformed and egregious President Pollack’s position is.

My first encounter with sexual health care at Cornell was when I booked an appointment to obtain birth control. The provider suggested an estrogen and progesterone based birth control. Although she mentioned some possible side effects, she neglected the risk of vulvar pain (estrogen-based birth control has been shown to increase the risks of vulvar pain up to 11-fold). She did, however, give me tips on how to please my partner.

The first, second and every other time I tried to have penetrative sex, I experienced excruciating and unbearable stabbing pain. I finally built up the courage and overcame my embarrassment to book a “Well Woman Visit” and write “pain with sex” as the reason for my visit. I told the clinician that I was concerned about the pain I had when attempting to have sex. I was surprised when she did not conduct an exam or even ask any follow-up questions about my pain. Instead, she merely asked if I was psychologically comfortable with my partner (to which I answered “yes”), and then she told me to “drink wine to relax” before sex. I was twenty at the time.

For another year, I had excruciating pain trying to insert tampons and attempting to have penetrative sex, and I found that no amount of alcohol could numb the pain. I anxiously counted down the months until my next annual Well Woman Visit. Because of the stigma and embarrassment, I hid my pain as best I could and told no one about it. Only my boyfriend at the time knew, because it was impossible to hide it from him.

At my second Well Woman Visit, I saw a different provider for my first-ever Pap smear. It was torturous. This provider recognized that something was very wrong. She recommended pelvic floor physical therapy, but I was terrified of the pain and therefore terrified to go. 

To persuade me, this clinician told me that, if I would not go for myself, I must go for my boyfriend, because “two years was too long to expect him to wait” to have penetrative sex. Even when I tried to tell her that he was okay with it, she insisted that I was being unfair to my current and future partners by “putting that kind of strain on the relationship.” I am ashamed to admit that this convinced me to go, and that, even now, I still struggle to believe that my worth as a partner and as a woman is not tied to my ability to be penetrated.

While I finally got some sort of treatment, it was entirely insufficient. It did not meet modern standards of care. The provider at Cornell Health diagnosed me with “vestibulitis” — a medical term that was discontinued around the time I was born (in the ‘90s by the International Society for the Study of Vulvovaginal Disease). She told me that this was entirely treatable with pelvic floor physical therapy, and did not refer to an outside M.D. gynecologist or even put in a follow-up to manage my care. Unfortunately, after five months of pelvic floor physical therapy, in the words of my physical therapist, I still had “unrelenting nerve pain.” I had to wait until I graduated to access an M.D. gynecologist in a vulvovaginal pain clinic who was able to diagnose and treat me. I finally got an accurate diagnosis (congenital neuroproliferative vestibulodynia — a condition, present from birth, in which there are extra nerve endings in the entrance to the vagina causing heightened sensitivity and pain). The gynecologist immediately took me off the birth control prescribed at Cornell Health because of the possibility of it aggravating my symptoms. In addition to pelvic floor physical therapy, her recommended treatments included a multitude of topical medications, systemic medications, Botox injections into the vestibule and even surgery. 

It is too much to expect that a nurse practitioner at Cornell Health be able to manage treatment for chronic pain conditions like this, but at Cornell Health, I received neither an accurate diagnosis, nor any of these treatments, nor even a referral to someone else able to manage my treatment. Instead, I was prescribed medication that may have even exacerbated the pain and sent on my way.

My family and I were thrilled that I was lucky enough to attend a world-class university, which we trusted to support my health, development and well-being. The lack of modern medical care at Cornell Health was a betrayal of that trust. The care I received lacked basic compassion, understanding, respect and competence. I was advised to self-medicate with alcohol before sex, and told by a healthcare provider, while at my most vulnerable, that another person’s libido takes priority over my pain, and that I cannot be a full partner unless I can endure penetrative sex. It has taken me years to understand how deeply wrong and harmful this so-called “care” was. I often wonder: How different would my life have been if, the very first time I raised a concern, it had been taken seriously and diagnosed and treated?

This was not a failure to address some rare disease afflicting only me. Up to 28 percent of Americans with vaginas experience chronic pain in their vulva or vagina during their lifetime. It is often first discovered in young adulthood. For this reason, it’s imperative that there be staff at Cornell Health able to recognize, diagnose and develop effective treatment plans for these serious conditions.

This summer, my mother and I wrote to President Pollack sharing my experiences and urging her to reconsider her position. We hoped that, when the harms caused by the lack of gynecological care at Cornell were brought to the President’s attention, she would recognize and address this issue — simply by hiring an M.D. gynecologist. The response we received from the President’s office not only lacked commitment to hiring such a provider, but refused to acknowledge any wrongdoing or harm done at Cornell Health and showed no interest in obtaining more information about what had occurred. The providers I saw are still on staff at Cornell Health, still seeing vulnerable patients and presumably still giving the same irresponsible, outdated and damaging “care.” My experience illustrates the need not only to have an M.D. gynecologist at Cornell, but to remedy the grossly outdated medical knowledge and worldviews pervasive among the sexual health staff at Cornell.

I remain deeply distressed that Cornell Health still lacks an M.D. gynecologist. It is unbearable to know that there are hundreds of young people living with undiagnosed gynecological pain conditions seeking help at Cornell Health. They lack even a chance to receive appropriate care and answers because the current providers are not equipped to help them. Instead, they will have experiences like mine. The only thing unusual about my experience is that I am talking about it.

Talking about this is no small feat. It has been very difficult for me to shake off the shame and feeling that this was my fault — that if I had been more insistent, or presented myself more credibly, that the clinicians might have taken me seriously and all of the subsequent impacts on my life wouldn’t have happened. And as recently as a month ago, I balked at the idea of writing anything identifiable because of the humiliation I would feel if people knew about my condition. I don’t want everyone to look at me and think that I have a broken vagina. 

But I’ve also seen how much good can be done by talking about this. I’ve seen women realize, for the first time, that a medical condition could explain their pain, and that it’s not all in their head, despite what they had been told. I’ve seen doctors begin to proactively ask their female patients about pain with sex, and vulvar experts volunteer their precious time to teach other providers about these conditions. And all of that is made possible by talking. So I am now sharing these experiences publicly, in the hope that other people struggling with these conditions will receive the support and medical care that they deserve. 

I’m particularly encouraged by the widespread support at Cornell: the Student Assembly, University Assembly, and Faculty Senate have recently passed resolutions urging Cornell to hire a M.D. gynecologist at Cornell Health to diagnose and treat vulvovaginal and pelvic pain conditions. In this area, Cornell does not hold a candle to its leading peers. Cornell has a population of about 25,000 students, and its health center has not a single M.D. gynecologist. Meanwhile, Yale has a population of about 12,000 students, and its health center has seven M.D. gynecologists on staff. Cornell’s continued refusal to hire a gynecologist effectively condemns hundreds of young people with vaginas to unnecessary years of pain without access to adequate medical care. This needs to change.

If, as has been suggested to me, Cornell’s reticence to hire an M.D. gynecologist is based on a concern about the cost of their salary, then I urge the University to do the following: Put a dollar amount on the health and well-being of every Cornell student with a vagina, and add it up. What is the total? (For reference, the salary of a gynecologist could be around $300K. Surely the University does not wish to maintain the position that each female student’s health and well-being is worth less than $25?) 

How many more stories like mine does President Pollack need to hear? And how many new ones is Cornell Health willing to create?

Consider my perspective as an alum. My family and I consistently receive donation requests, but we cannot bring ourselves to donate to an institution that caused me such harm, is aware of it and refuses to rectify the circumstances that directly led to that harm — especially when the solution is as simple as hiring one person. Were I to donate, I would feel complicit in the harm this University is actively perpetuating against its female students. I will continue to follow and press this issue, and I urge my fellow alumni to do the same.

My ultimate purpose in writing is to encourage Cornell students, faculty, staff, alumni & donors to continue to push for hiring an M.D. gynecologist able to diagnose and treat chronic vulvovaginal and pelvic pain conditions. Every day that goes by without such a provider risks subjecting another person to excruciating pain and sexism at Cornell Health.

Marlene Berke ‘19 is a graduate from the College of Arts & Sciences. She is currently a Ph.D. candidate at Yale University, and a founding member of the New Haven chapter of Tight Lipped, a national advocacy organization by and for people with vulvovaginal and pelvic pain. She can be reached at [email protected].

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