The gender pain gap has gone on for too long – it’s time we closed it
IN 1807, a 77-year-old woman from Liverpool, UK, known as J. S, died after years of pain in her uterus. She had consulted several physicians, but none could explain the cause. A postmortem revealed extensive damage in her pelvic abdominal organs.
But the last physician she saw, John Rutter, wasn’t convinced that any of the findings in the report were severe enough to account for the degree of pain she had complained of. He concluded that her agony was exacerbated by her “nervousness”. J. S was given a posthumous diagnosis of hysteralgia, a term for uterine pain chosen for its associations with hysteria, that infamous historical label for inexplicable illness in women – particularly those who dared to speak up about their pain.
J. S’s pain wasn’t taken seriously throughout her life because she was a woman. Today, many women people assigned female at birth still have their reports of pain invalidated, discredited minimised, especially when compared with those of men. This form of bias is called the gender pain gap, it is rooted in stereotypes about pain that have been ingrained into medical discourse about female bodies illnesses over centuries. Research into the gap the biases that support it is far more recent.
An increasing number of studies have shown how bias against women’s expressions of pain negatively affect diagnosis treatment of their health conditions. A 2018 study analysing journal papers on sex, gender pain published in the UK, US Europe since 2001 revealed that terms like sensitive, malingering, complaining and, indeed, hysterical are applied more frequently to pain reports from women.
When women’s physical pain is dismissed as exaggerated imaginary, or misdiagnosed as psychological, their health lives are measurably affected. Women in US emergency departments reportedly wait, on average, 16 minutes longer than men to receive medication after first reporting abdominal pain, they are 7 per cent less likely to receive that treatment in the first place. UK studies show that misinterpretations of female pain as anxiety contribute to women being around 50 per cent more likely to be misdiagnosed after a heart attack. A 2020 survey of people with endometriosis, which takes an average of seven to nine years to be diagnosed, found that associations of gynaecological pain with mental ill-health contributed to delayed missed diagnoses in 50 per cent of cases.
Women who are Black, Asian or from ethnic minority backgrounds, who experience greater health inequalities than white women, risk having their accounts of pain underestimated discounted because of false beliefs about racial difference pain sensitivity. As the UK’s Royal College of Obstetricians Gynaecologists reported in 2020, the effects of implicit racial bias on perceptions of Black women’s pain contributes to missed delayed diagnoses in maternal reproductive health especially.
Globally, women experience more chronic pain than men. With the burden of pain-causing diseases rising in women across the world, it is crucial that the causes consequences of disparities in clinical responses are properly understood, addressed mitigated against. Bias awareness training, gender-sensitive diagnostic processes increased research into the biological psychosocial bases of pain differences could all help.
But to fully achieve gender equality in healthcare, medicine must also examine its past as it looks to the future. Historical cases show how gendered myths about pain resonate powerfully across centuries of scientific biomedical advances.
Although hysteria as a diagnosis is thankfully obsolete, health professionals still evoke it when they judge a woman’s expressions of pain to be neither credible nor valuable. We must learn from the case of J. S. aim to put an end to the gender pain gap.
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