1. A Comparison of Treatment Rates for Dyspareunia Amongst Language Groups
Natalie Eisenach MD, MS-CR Candidate
Department of Preventive Medicine and Public Health
University of Kansas Medical Center

2. Outline
Background
Purpose
Methods
Results
Discussion

3. Background Dyspareunia: Type of female sexual dysfunction
Recurrent or persistent pain with sexual activity that causes marked distress or interpersonal conflict. (Seehuesen, 2014)
Affects 8-22% of women (Steege,2009)
Not just menopausal women (Sobghol,2007)
Numerous etiologies for pain:
Anatomic
Physiologic
Psychologic

4. Background Continued Frequently underreported and undertreated
Tools like the Female Sexual Function Index aid in diagnosis
Treatment options:
Pharmaceuticals
Pelvic Floor Physical Therapy
Trigger Point Injections
Surgical
Counseling and Therapy

5. Purpose Current literature is lacking
Few studies published from America
Limited knowledge on treatment rates
Limited understanding on language’s impact on patient care
Greater support and treatment for chronic muscular pain when health care provider showed proficiency in patient's language (Riffin, 2016)
Dyspareunia greatly impacts quality of life
Missing opportunities to diagnosis/treat dyspareunia

6. Purpose Continued Aims
Utilize data from the EMR to identify treatment rates for dyspareunia between different language groups
Hypothesis
Women who speak English will have higher rates of treatment for dyspareunia compared to Non-English speaking women

7. Methods
Retrospective cohort study of all women diagnosed w/ dyspareunia at KUMC since 2007
Steps:
Collection of EMR data through HERON (Healthcare Enterprise Repository for Ontological Narration)
Data cleaning and organization with SQL-Lite
Calculation of final treatment rates in Excel
Statistical analysis completed with SAS

8. Collection of Data LANGUAGE and INTERPRETER USE
SETTING: OB/GYN (IDX and UHC)
DX CODES:
ICD9 – 625.0
ICD10 – N80-N98
TX CODES:
ESTROGENS, PT REFERRAL ORDER, INJECTIONS and MESH INSERTION (CPT-4)

9. Data Timeline Initial Dyspareunia Diagnosis First of Treatment X
OB/GYN CLINIC
Initial Dyspareunia Diagnosis
First of Treatment X
First of Treatment Y
First of Treatment Z
Record of Interpreter Use (Any Point in Record)
* Treatment types not required in a specific order or at time interval.

10. Women w/ diagnosis of dyspareunia (n= 3,106)
Excluded (n=53):
- ICD : Psychogenic dyspareunia
Diagnosis w/ ICD or ICD10 N80-98 only
(n=3,053)
Diagnosis starting 1/1/2007
(n =2,463)
History of Interpreter Use
(n=33)
Treatment Date ≥ Dx Date
(n= 584)
Treatment w/ Surgical Mesh Placement
(n=4)
Treatment w/ Estrogen
(n=262)
Treatment w/ Trigger Pt. Injection
(n=110)
Treatment w/ PT Referral
(n=208)

11. Results

12. Interpreter Use: Count
Final Data Summary
Treatment Type Counts
Language
Pt Count
Avg. Age at Diagnosis
Interpreter Use: Count
Estrogen PT
Trigger
Mesh
English
2360 42 2
256
207
108 3
Spanish 45 40 21 5 1
Not Entered 28 35
Burmese 8 33
Other 6
Russian 47
Chinese 54
Chinese (Mandarin) 43
Unknown 32
Arabic 38
Chin 29
Danish 24
Laotian 27
Nepali
Somali 50
Vietnamese

13. Language Breakdown

14. Age Analysis
Range for all languages: 13-87

15. Comparison of Age at Diagnosis
T-test results :
English: (mean age at diagnosis)
Not English: (mean age at diagnosis)
Statistically Significant: p=0.0007, Non-English speakers diagnosed at younger age

16. Comparison of Treatment Rates

17. Association of Language and Treatment
Summary Chi-Square Test:
Low frequency for many cells, use exact test
p=0.0222, supports an association between language and treatment

18. Association Continued
Applied standard residuals
Mesh treatments > | 2|
Fewer subjects were observed in Language/Mesh combinations than what we would expect under independence
Surgical options contribute to overall significance of Chi-Sq

19. Discussion
Aim: Use EMR data to identify treatment rates for dyspareunia amongst different language groups
2,360 English speaking women and 103 Non-English speaking women diagnosed w/ dyspareunia
Non-English speaking women diagnosed on average ~4 years earlier when compared to English speaking women
Higher rates of treatment in English speaking cohort, but still small (all under 12%)
Significant association between patient’s language and treatment
Strong contribution from surgical treatment

20. Limitations EMR User Error: Not entered and unknown frequency high
Interpreter use recording rates
Timeline
100% estrogen use amongst ALL patients when timeline removed
Is methods capturing all treatments associated w/ diagnosis?

21. Future Directions
This study was able to highlight a disparity in Women’s Health
Future Goals:
Research barriers to treatment through future survey of all Spanish and English speaking patients in gynecology clinics
Improve access to care for all patients through improved healthcare communication

22. References
Seehusen, D. A., et al. (2014). "Dyspareunia in women." Am Fam Physician 90(7):
Steege, J. F. and D. A. Zolnoun (2009). "Evaluation and treatment of dyspareunia." Obstet Gynecol 113(5):
Sobhgol, S. S. and S. M. Alizadeli Charndabee (2006). "Rate and related factors of dyspareunia in reproductive age women: a cross-sectional study." Int J Impot Res 19(1):
Riffin, C., Pillemer, K., Reid, M. C., & Lckenhoff, C. E. (2016). Decision Support Preferences Among Hispanic and Non-Hispanic White Older Adults With Chronic Musculoskeletal Pain. J Gerontol B Psychol Sci Soc Sci, 71(5),

23. Questions?