The gender (and racial) pain gap – it’s not new, but can we close it?
(Warning – skip the first few paragraphs if you have a weak stomach!)
In 1808 a physician called John Rutter gave a talk to colleagues in Liverpool about a case of Hysteralgia – or hysterical pain. The woman he was describing was known as J.S. She died in pain at the age of 78 and, at her request, an autopsy was performed.
Rutter outlined her medical history as best he could. He described letters she’d written to her previous doctors since her mid 20’s complaining of increased vaginal discharges, painful breasts, sweating, ringing ears, palpitations and faintness.
In her early 30’s she had pain in her pelvic region that she thought emanated from her uterus. Later she felt a lump which grew to “the size of a child’s head” and protruded out from her belly until it eventually burst and emptied itself into her rectum – a process that went on for many months and then occurred repeatedly over the years.
In her 50’s she complained of a sense of heat and pain in her lower abdomen that was worse when she walked or raised her arms. These ‘complaints’ continued until she finally passed away in 1807 and was opened up to see what was going on – and it was quite a lot.
While her kidneys and uterus were ok there was a long litany of other issues (including but not all):
- A distended colon (6 inches in places) with hardened stools was pushing downwards on other tissue
- The uterus had attached itself to surrounding gut tissue (which Rutter noted required considerable force to detach!)
- There were tubercles or lumps that had appeared that were inflamed and hardened
- There was a cyst that was about 4 few inches in length that was protruding into the surrounding tissue and muscles
- Her bladder was thickened and distended
- She had gangrene of the labia and anus.
Yet, despite all of that, Dr Rutter determined that her pain was imagined. He wrote: “She was mistaken in her belief of the source of her pain. … It appears most probable to me that this symptom was hysterical. The constitution of this patient was disposed to hysterical affections.”
Predisposed to hysteria
Why am I telling you this? Because, 200 years later, it seems that very little has changed when it comes to women and pain.
Nurofen has just released a study about the gender pain gap that showed that 56% of women thought their pain was ignored or dismissed while 49% of men felt the same way. One in four (25%) said they felt their pain wasn’t taken seriously compared to 1 in 6 or 15% of men.
Patient perception is one thing, but study after study has shown that gender bias is a real thing – and it can have deadly ramifications.
A 2018 study looked at 77 research papers that showed how women were treated differently when it came to pain across several health areas including neck pain, psoriasis and heart disease. It said men were described as being “stoic” and women more “sensitive” to pain. It also outlined how men’s pain was considered “normal” but women’s was an “irregularity” and was often described as being without an identifiable origin. Women were described as being “malingerers” or it was said that “the pain is all in her head.”
It’s all in your head
Studies show that women’s pain is consistently rated as lower than men’s pain and that women are more likely to be recommended for psychotherapy for their pain than men.
One of these studies involved ‘perceivers’ looking at videos of men and women with shoulder pain and evaluating how intense the pain was. Men were perceived to be in more pain than women based on their facial expressions. On average women were rated 2.45 points lower than men in terms of main. The authors wrote: “perceivers judged female patients as relatively more likely to benefit from psychotherapy, whereas male patients were judged to benefit more from pain medicine.”
Another study found similar results for women with endometriosis. Their pain was either put down to “another physical condition” or considered to be psychological – both of which contributed to a delay in diagnosis. Some “75.2% of patients reported being misdiagnosed with another physical health (95.1%) and/or mental health problem (49.5%) and most frequently by gynaecologists (53.2%) followed by general practitioners (34.4%),” the authors wrote.
When this becomes life threatening is when it comes to heart health. The British Heart Foundation says women are 50% more likely to receive the wrong diagnosis when it comes to a heart attack, are less likely to receive the same treatments or preventative medications as men, and, they have a 70% higher risk of dying.
If all this isn’t enough to make your blood boil – spare a thought for our Asian, brown and black sisters. Cultural biases mean that people of colour are perceived as having ‘thicker skin” and according to a 2016 study of white American 1st and 2nd year medical students and less nerve endings, so don’t feel pain as much.
And, a 2012 meta-analysis of pain management over 20 years found that black and Hispanic groups were less likely to be treated for pain in the same way as their white counterparts in virtually all conceivable settings – and it hadn’t improved over time. Another study found that black people were systematically under-treated for pain.
Time to change the narrative
The problem with pain is you can’t see it. It’s well documented that women have more chronic pain than men – often centred around the pelvic/reproductive region. It can be debilitating, depressing and demoralising and you may think you’re a burden or that it’s ‘boring’ for those around you.
But it’s important to know that you deserve to be heard and to get the help you need – irrespective of race or gender.
I suspect that J.S. asked for an autopsy because she wanted to prove posthumously that she wasn’t just making her pain up – she may not have pinpointed the exact organ responsible for her pain, but even with all that going on she wasn’t believed!
But have we really come that far? These studies suggest we still have a long way to go – so now’s the time to start working to change those biases.