Is women’s pain treated differently by clinicians?

Reproductive Health

A: Yes, and women are also more likely to experience chronic pain than men.

In the past few months, the New York Times and Serial productions released a podcast called “The Retrievals.” This gripping series told the stories of women who underwent egg retrievals (an invasive surgical procedure) with no anesthesia at a Yale University infertility clinic. It turns out a nurse had been stealing fentanyl and replacing it with saline. But the podcast series opens up larger questions about women and pain, the most urgent and distressing of which is the question of why no one responded appropriately to the women when they said they felt pain during the procedure. It took longer than it should have for the situation to be investigated.

In some ways, this story should not be so surprising. Consider a few statistics about women’s experience with pain in medical settings, according to Harvard Medical School:

✳️ Women who undergo coronary bypass surgery are about half as likely to get painkillers as men who undergo the same procedure.

✳️ Women wait an average of 65 minutes to receive pain meds in response to abdominal pain in the ER versus men, who wait an average of 49 minutes.

✳️ Women are 7 times more likely to be misdiagnosed and discharged in the midst of having a heart attack than men.

✳️ A brand new study just found that female sex is associated with a longer “door-in-door-out” time (time of transfer out minus time of arrival) for strokes in emergency departments, while better stroke outcomes are significantly associated with shorter “door-in-door-out” times. In other words, women experiencing strokes were more likely to spend longer in the ED, usually waiting for further treatment.

What might be behind some of these alarming differences? For one thing, medical training rarely accounts for differences between men and women.. Most doctors are trained to recognize and treat diseases as they unfold in an average-weight male. There is very little to no discussion about how symptoms might present differently in women or how we might need to rethink our assumptions about certain medical conditions to account for sex differences.

Another issue arises around chronic pain. Many chronic conditions like fibromyalgia or chronic fatigue syndrome are more prevalent in women. Too often, these painful conditions are characterized as “psychosomatic,” with a strong suggestion that these conditions are “all in the person’s head.” There is a pervasive gender stereotype suggesting that women are overly dramatic about the pain they experience.
The situation is even worse for Black women. We’ve written a few posts on the staggering problem of Black maternal mortality in the U.S. All of the problems described above are magnified and exacerbated in Black populations. A combination of dismissal of women’s pain and an enduring underlying belief that Black people have a higher pain tolerance can lead to a broad failure to acknowledge truly painful conditions that should be treated and taken more seriously.

The bottom line? If you think a clinician is dismissing or not taking your pain seriously, it may not all be in your head. Discuss these issues explicitly and know that you are your greatest advocate.

Those Nerdy Girls

Further Reading:

Useful summary of the sex disparities in treatment of pain

Essay in The Atlantic about discounting women’s pain

Cleveland Clinic summary of research about women’s experience of chronic pain

Serial/New York Times series “The Retrievals”

Summary of research on gender stereotypes about pain

New study on door-in-door-out time in the emergency department for strokes

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