Why is female pain taken less seriously than men's?
By Gabrielle Jackson 18 November 2019 • 12:12pm
Almost half of women eventually diagnosed with an autoimmune condition will have been told by a doctor that they're hypochondriacs
A woman who complains about lots of different symptoms, who demands answers, is still seen to be 'difficult' by society. But instead of medicine continuing to write these woman off as mad, isn't it about time they starting listening and investigating?
A woman presenting with a variety of generalised symptoms including headaches, poor sleep, constant pain, anxiety, bloating, sensitive bowels, fatigue, stabbing pains in the abdomen, sore lower back pain, pain down the front of the legs, pain during sex, heavy bleeding and period pain is today likely to be written off as "difficult" or "depressed" or "highly anxious" by even the most caring doctor.
But this isn't a strange combination of symptoms, it's actually typical for a woman with endometriosis.
Endometriosis has been in the medical journals for well over a century and yet there is still no known cause or cure and a tragic lack of understanding of the mechanisms at play. It affects the same number of women as diabetes but is funded at 5 percent of the rate. How do doctors respond to this lack of knowledge?
One South African gynaecologist wrote that since only Type A personalities get endometriosis, it could be cured by stress management classes. Another wondered out loud to an Australian researcher, "Do mad people get endo or does endo make you mad? It's probably a bit of both."
It's attitudes like these that result in doctors diagnosing more women than men with depression, anxiety and post-traumatic stress disorder. Yet chronic pain conditions and autoimmune diseases are beset by huge delays in diagnosis.
For endometriosis, the delayed diagnosis is somewhere between seven and 12 years. For systemic lupus erythematosus it's between six and seven years. Sixty-three per cent of lupus sufferers report being misdiagnosed. Of those, more than half had to see four or more different healthcare professionals to receive a correct diagnosis.
Male vs female heart attacks
Almost half of women eventually diagnosed with an autoimmune condition will have been told by a doctor that they're hypochondriacs or that they are too concerned with their health.
Similarly, women's reports of pain are are far less likely to be believed or treated than men's.
In a 2001 paper, "The girl who cried pain: A bias against women in the treatment of pain", authors Diane Hoffmann and Anita Tarzian drew on a vast number of studies to show how poorly women's pain was treated and showed how they commonly have their pain written off as a mental health condition.
The paper showed that both doctors and nurses tended to give women less pain medication than men after abdominal surgery; that post-operatively boys were given codeine and girls paracetamol; that among both cancer and Aids patients, women were more likely to be undertreated for their pain than men; that women with chest pain were less likely to be admitted to hospital; and that pain clinics treated women with more minor tranquillisers, antidepressants and non-opioid analgesics than they gave to men, while more opioids were given to men.
Endometriosis symptom checker
So, why the readiness to diagnose women with mental illness and the reluctance to investigate pain and diagnose serious conditions?
To answer that question, we have to delve into the history of medicine. From the birth of medicine in ancient times until the early modern era, the womb was blamed for almost any illness that befell women, many of them gathered under the label "hysteria"; then around a century ago, hormones came to be seen as the major culprit.
The Victorian age was the pinnacle of hysteria, which was first believed to be a physical disease and brutal surgeries and treatments were performed in efforts to cure it.
Later, Freud and others helped popularise the notion that it was all in the mind - a deceptive and manipulative mind of a woman who could not be trusted to give a reliable account of her own health.
In this way, "difficult women" have been policed by society, with the help of medicine, for centuries. Deep inside the collective knowledge of medicine is the idea that women are inherently unstable and not to be trusted.
While the word "hysteria" eventually disappeared as a medical diagnosis, it has not disappeared from social use as a pejorative insult all too often reserved for women. And its legend lives on in how doctors treat women today, especially those they don't have answers for. Research has shown that hysteria narratives start to emerge when a doctor has run out of ways to try to help a patient, so it is particularly prevalent in conditions where medicine lacks knowledge, such as borderline personality disorder, fibromyalgia, and "medically unexplained symptoms".
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Doctors don't have the knowledge or the tools to treat conditions predominantly affecting women because medical science has never bothered to investigate them. Throughout medicine's history, man has been the default human being – any difference was considered abnormal and deficient. Women were considered men with wombs and only male biology was studied – any differences in health were considered due to the womb, hormones or mental incapacity and therefore uninteresting and not worthy of scientific pursuit.
As Dr Janine Austin Clayton, the director of the US Office of Research on Women's Health, told the New York Times: "We literally know less about every aspect of female biology compared to male biology."
This has led to health disparities across the board – not just in conditions that predominantly affect women, such as chronic pain and autoimmune diseases, but also in conditions that affect both men and women. A 2018 study found that women were half as likely to be treated properly for a heart attack as men and twice as likely to die six months after discharge. They are more likely to be disabled after a stroke and it takes longer for cancer to be diagnosed in women than men. While women may have historically lived longer than men, the gap is closing and men now live more healthy, active years than women.
A woman who complains about lots of different symptoms, who demands answers, who draws attention to her problems and doesn't accept the authority of her doctor is still seen to be 'difficult' by society and put in the 'too hard' basket. But instead of medicine continuing to write these woman off as mad, isn't it about time they starting listening and investigating?
What is actually crazy is that so little effort, money or policy has been put into finding out more.
Gabrielle Jackson is the author of Pain and Prejudice: A call to arms for women and their bodies (Little, Brown).
Inequality,
Sexism,