Two big advances in women's health have been in the news recently: a less invasive alternative to the Pap smear, long considered an unpleasant but necessary evil for screening for cervical cancer, and new pain-management guidelines for the insertion of the IUD, a highly effective contraceptive that many women say hurts when inserted into the uterus to prevent pregnancy.
That women experience pain disproportionately in healthcare settings is nothing new. Studies have shown that women experience higher levels of pain than men, on average, and by large margins. Yet their discomfort is often undertreated and ignored. Women in pain are more likely than men to be prescribed sedatives instead of painkillers, and one study found that women who had coronary artery bypass surgery were half as likely to be prescribed painkillers as men who had the same procedure.
Why has women's pain been ignored for so long?
Women's pain and discomfort in medical settings have long been ignored and misunderstood, primarily because women's bodies and health have been misunderstood. That misunderstanding dates back to the 3rd century BCE philosopher Aristotle, who believed that women's bodies were the inverse of men's, with their genitals “turning from the outside inwards.” As a result, the way women have traditionally been treated as patients often reflects old prejudices.
“The origins of the term hysterectomy come from the idea that 'hysteria,' a mental disorder involving uncontrollable emotions, is unique to women and rooted in the uterus,” Beth Darnall, a clinical pain psychologist at Stanford University, tells Yahoo Life.
This tendency to attribute women's pain to emotions is still present in today's medical community: The Washington Post reported a study that found that “middle-aged women with chest pain or other symptoms of heart disease are twice as likely to be diagnosed with a mental illness as men with the same symptoms.”
David Thomas, special advisor to the Institute for Women's Health director, tells Yahoo Life, “Compared to men, women are more likely to be prescribed anti-anxiety medications for pain, while men dismiss pain as an emotional response. And unfortunately, the failure to listen to women in clinical settings goes far beyond the issue of women reporting pain.”
Dr. Kristen MacKenzie, assistant professor of anesthesiology at Stanford University, explains that mainstream culture has historically viewed feminine aspects like menstruation, childbirth, and menopause as inherently unpleasant, and that women have just “dealt with it” for centuries.
“This creates the assumption that if you're complaining about pain, the problem is not with your physical situation, but with your pain tolerance,” MacKenzie tells Yahoo Life.
Medicine also has a long history of not including women in studies to better understand women's health conditions. For example, in a 1977 policy (later rescinded in 1993), the Food and Drug Administration banned women of reproductive age from participating in early clinical trials, even if they were using birth control or their husbands had had vasectomies. The goal was to prevent fetuses from being exposed to experimental drugs, but the result was a lack of data on how those drugs affected women.
“Historically, women's health care has received less attention, research and funding, and that impacts the state of women's health today, including how we measure, study and treat pain,” Eileen Aninye, chief science officer at the Society for Women's Health Research (SWHR), tells Yahoo Life. “For a long time, women were seen as no different to smaller men when it came to health,” meaning women's pain was seen as a “tinier version” of men's pain. “So conclusions about men were assumed to apply to women, but we now know that's wrong. There are important gender differences when it comes to health and pain.”
How things are changing
In some ways, women's health care has changed little: Speculums have barely been improved in 170 years, while the forceps commonly used to insert intrauterine devices and examine the cervix were invented 135 years ago by French surgeon Samuel Pozzi, the father of modern gynecology, and were inspired by a Civil War-era American bullet extractor.
But experts say there has been progress in taking women's symptoms and pain more seriously.
“There's a growing awareness of common biases, including gender bias, and a cultural movement toward equity,” Darnall says. “For example, the National Institutes of Health requires researchers to consider sex as a biological variable in their studies so they can gather evidence about women and understand how to best serve their unique needs.”
She added: “If there was a higher proportion of female doctors, that might be different. Last year, 55% of medical students were women.”
Anigner said there has been a lot of attention given to conditions that are specific to women (such as endometriosis and menopause) and illnesses that are disproportionately prevalent in women (such as migraines, which are twice as common in women as in men, and autoimmune diseases, where 80% of cases are diagnosed in women), but she said there is “still a lot of work to be done to bring these topics into the mainstream.”
One challenge, experts say, is that pain is subjective and personal, and Thomas says one area of research the NIH is focusing on is finding “objective measures of pain” to eliminate some of the bias in treatment and diagnosis.
“An objective measurement of pain, rather than some sort of 0-10 scale, would hopefully highlight that people are experiencing pain, what type of pain it is, and suggest potential treatments,” Thomas said. “Patients' voices are often ignored or dismissed, but the hope is that hard scientific data can't be ignored.”
What can women do to make their voices heard?
Experts offer tips for discussing pain or discomfort, and bringing other health concerns to a health care professional.
Find a doctor you trust. Seek medical advice or treatment from a doctor you trust to be empathetic and understand your concerns. “Patients should find a doctor they can trust based on past experiences with that doctor or trusted recommendations,” says Dr. Paula Castaño, associate professor of reproductive health at Columbia University.
Ask questions. McKenzie says it's helpful to bring a list of specific questions to your appointment and let your doctor know you'd like to review the list with them beforehand. “Many patients are concerned that they've missed a certain diagnosis, and they should bring that up to their doctor so they can get a clear resolution or a referral to a specialist,” she says. And if you're considering a medical procedure, ask your doctor about any pain you might experience and what pain management is available.
Bring a support person with you: “Going to the hospital can be scary or overwhelming, so I encourage patients to bring a trusted friend or family member with them who can ask questions and provide support,” Castaño says.
Stay calm. If your concerns are ignored, be persistent. “Feeling ignored can be frustrating,” says Darnall. “It's best to stay calm and restate your main question or concerns. Request more information so you understand the treatment plan and options.”
Get a second opinion. If your current doctor isn't answering your questions or providing you with the information you need, find one who will listen to your concerns. “As a patient, you have the right to as much information as you need until you feel comfortable with your health care decisions,” says Agnier. “Unfortunately, it's not uncommon for many women to have to visit multiple doctors to receive an accurate diagnosis or solidify an effective treatment plan for their condition.”
Share your story. McKenzie says women sharing their stories on social media is already making a difference by raising awareness among both the public and health professionals. “Women have a right to have these conversations with their health professionals without the expectation that they should suffer just because other women have suffered before them,” she says. Aninye agrees. “Sharing first-hand stories can lead to powerful connections and create real change in healthcare, research and policy. Women should share their health stories in places and times where they feel comfortable. Speaking out can raise awareness about women's health and even influence research and funding decisions.”
