I had a headache that lasted for years. It was there when I woke up and there when I went to sleep. I got so used to it that one day, when my husband, bemoaning a rare headache, asked if we had any painkillers, I realized that for me the exceptional day was not having a headache. The doctors I consulted suggested a whole range of reasons and prescriptions, but none helped. Turns out, I did what most women not only do but are encouraged to do: live with the pain and discomfort.
All over the world, women, for a variety of reasons, experience much higher rates of pain, and degraded care for that pain, than men do. More than 100 million Americans report living with chronic pain, and the vast majority are women. Yet, doctors routinely discount women’s experiences of pain as emotional or psychological discomfort that aren’t “real.” …
First, people have a difficult time recognizing women’s pain. Not in an abstract sense, but in an actual, practical, “Does that expression on her face mean she is in pain?” way. People are much better at reflexively decoding pain when a man’s face reflects it than when a woman’s does.
This is also true when a white person is experiencing pain versus a black person. Interestingly, when a person’s face is androgynous and displaying pain, observers identify it as male. Even if and when girls and women say, out loud, that they are experiencing pain, people, including medical professionals, are more likely to minimize or dismiss what they say. On one end of the spectrum, this problem results in real discomfort for girls and women, on the other, misdiagnoses, exacerbated pain, and higher likelihood of mortality.
Second, gender bias and stereotypes infuse the way doctors treat women’s pain. A 2014 survey of more than 2,000 women, conducted by the National Pain Report and For Grace, a non-profit devoted to finding solutions for women in pain, found that three quarters of the women surveyed were told at least once by a doctor that nothing could be done for them and that they would just have to live with chronic physical hurt.
-57 percent report being told by a doctor, “I don’t know what’s wrong with you.”
-51 percent report having doctor’s say, “You look good, so you must be feeling better.”
-45 percent reported that they were told, “The pain is all in your head.”
My personal favorites? “You are too pretty to have so many problems,” and “You can’t be too sick because you have makeup on and you are not in your sweatpants.”
Third, men and women experience different kinds of pain differently, but women report feeling more intense pain. However, when men report pain, they are treated more seriously. Doctors, for example, are more likely to prescribe painkillers for men, but sedatives for women. One study showed that men are also more likely to be sent to intensive care units. In an extensive essay on pain last year, Judy Foreman shared research showing that women are far less likely to get hip or knee replacements and that doctors are disinclined to think that women have heart problems, even when they have symptoms. Women are more likely to seek treatment for chronic pain, but are also more likely to be inadequately treated by health care providers.
Fourth, there is an additional aspect of pain recognition and relief that, despite being tracked for decades, remains under-examined and misunderstood by doctors. Despite the fact that men have higher rates of recognized trauma leading to post traumatic stress disorder, women are more than twice as likely to have anxiety disorders and to report fatigue than men. Women’s higher rates of symptoms for PTSD has puzzled doctors, who frequently write the effects off to women’s nerves or over-emotionality. However, researchers have documented the link between concerns about physical safety and psychological harm. Consider, for example, that before puberty, boys and girls experience depression and anxiety at similar rates, but, upon puberty, when street harassment, awareness of physical vulnerability and rape begin, girls’ are up to six times as likely to suffer from anxiety as teenage boys.
Researchers have now concluded that women are more likely to have a whole host of physical problems due to the accumulated effects of hyper-vigilance, sexual objectification, and harassment. Recently, scientists at the University of Mary Washington’s Psychology Department showed the effects of sexual harassment on women, effects that are even stronger in women who have been sexually abused. They concluded that women are experiencing “insidious trauma,” something most doctors are oblivious about.
Lastly, medical research continues to fail to take sex-specific issues into account, mistakenly assuming that male, mostly white male, test subjects sufficiently represent all of humanity. This discriminatory skewing of research, in favor of male physiology, has considerable impact on women’s health, including pain and pain mitigation.
Sometimes, the effects of sexism and implicit gender bias are difficult to show. However, in the case of women’s health care, there’s very little ambiguity. Women should be aware of what these problems look like, so that they can identify doctors who similarly understand them and can fairly diagnose and treat them. Both male and female doctors have these biases, but, it is noteworthy that today, in the United States, despite gains in women’s education, men make up more than 66% of the nation’s doctors still. Their bodies and experiences matter in terms of defining medical cultures and practices.
All of what I describe above are globally true. These forms of bias and their effects are compounded by other factors for many people. Black women in the United States, for example, suffer the double jeopardy of racism and sexism. Transgender people face persistent obstacles to getting the health care they need. Those with disabilities encounter heightened challenges across the board. There is a clear and consistent relationship between bias and clinical approaches that requires systemic interventions that appear to be few and far between.
Last year, I had occasion to visit my doctor, who prescribed some medicine. When I asked him if any of the clinical trials for the medicine had included women, he admitted that he didn’t know, but assured me that it was the best solution available. So I looked it up. The trials showed that the medication worked for men, but actually had several high risks and contraindications for women. So I found a new doctor, one who didn’t dismiss my concerns with a paternalistic and sexist arrogance.