“There are many barriers to accessing care for both pelvic and sexual pain, the first one being the stigma,” Sonia Bahlani, M.D., a New York-based OB/GYN specializing in pelvic pain, tells mbg. “Sexual and pelvic pain is often under reported and misdiagnosed because many delay or refuse to seek care because of the shame and stigma associated with these disorders.”

In general, talking about sex in a healthcare setting can feel really intimidating, embarrassing, or even traumatizing for some people, especially if you have to take the initiative and bring it up because your doctor didn’t ask. A 2012 study found only about 40% of OB/GYNs ask about sexual problems, and a quarter of OB/GYNs also express disapproval of their patients’ sexual habits when these conversations come up. And many people who deal with pelvic pain say they’ve found their concerns being dismissed or not taken seriously.

“I see many women in my office who have tried to have this conversation with their general OB/GYN or family doctor and have been told ‘it’s all in their head’ or ‘all women have pain’ or ‘just have a glass of wine before,’” Bahlani explains. “They often come into the conversation, previously being dismissed, and this can make it so hard to try to approach the conversation again or realize that there is so much we can do to help.”

Emily Sauer, the founder and CEO of OhNut, a simple wearable tool designed to help people who experience pain during intercourse, herself experienced this type of dismissal by gynecologists for over a decade. “My questions about painful sex would be a nuisance to a doctor who has 15 minutes for an appointment, and who is equipped with a toolkit that pushes surgery and medication—over quality of life,” she tells mbg.

Our medical institutions in general have historically revolved around the male biological template, Sauer adds, and there’s a severe lack of both research and education around female sexual concerns and pelvic health. That means not only do many doctors know little about how to address women’s sexual pain, but many women themselves don’t even know how to explain the pain their experiencing.

“With our current lack of sexual and pelvic education, it’s nearly impossible for us to know what’s ‘normal’ or ‘not normal,’ how much pain is too much, even to have a basic anatomic understanding in order to explain where things feel a certain way,” Sauer explains. “Without language, particularly language that we’re not embarrassed by, how can we begin to advocate for our health?”