Lost in Translation: How Language Around Women’s Pain Creates The Pain Gap

By Bethan Charles 

The morning before my thirtieth birthday, pain stabbed at my abdomen. I could barely walk, had a temperature, felt nauseous. Above all, I was frightened. 

I spent the last day of my twenties glued to my phone, on hold with the GP. When I got through, they asked me to rate the pain on a scale of 0 to 10, with 10 being the worst I could imagine. I did not know what to imagine, so I guessed a 6.5. Non-urgent, in their opinion. 

After a blood test, an automated report assured me that everything was normal. But I was still in immense pain. When I phoned the doctor, they agreed my condition was ‘curious’. However, once I linked the pain to my womb area, they sighed – almost, I thought, in relief – and suggested the culprit could be an ovarian cyst. Their casual attitude surprised me. I assumed I must have been overreacting – especially when they described my pain as ‘discomfort’. 

Months later, after experiencing regular bouts of intense pain, I passed kidney stones.

Afterwards, instead of spending hours on hold, the doctor phoned back within minutes of my first enquiry. They immediately prescribed strong relief for the ‘excruciating’ pain I must be experiencing. 

While I am grateful for the doctor’s response and their help through my recovery, I found the experience bizarre. Kidney stones were the problem the entire time. The pain was the same. Except the pain was labelled as ‘discomfort’ for a suspected ovarian cyst but ‘excruciating’ for kidney stones. 

How can such different language be used to describe identical pain? As a scientist by training, I turned to recent research for answers. The critical problem appeared to be simple and, unfortunately, unsurprising. While kidney stones can affect everyone, ovarian cysts only affect people with wombs. 

The gender bias in language has ancient roots. For example, the word hysteria (derived from the Greek word for womb) was once a common diagnosis for women experiencing ‘emotional excess’. Hysteria was first used in Hippocratic-era medicine over 2000 years ago. It was only scrapped as a diagnosis in 1980.

In 2001, Hoffmann and Tarzian wrote a paper called ‘The Girl Who Cried Pain: A Bias Against Women in the Treatment of Pain’. They stated: ‘women are more likely than men to be undertreated or inappropriately diagnosed’. This is as true today as it was two decades ago. Women and people with wombs can expect to experience longer waiting times in A&E and are less likely to be prescribed strong painkillers than men. 

Studies have also suggested that some medical professionals take women’s health issues less seriously. These problems contribute to the gender pain gap, highlighted by the all-party parliamentary group (APPG) on endometritis in 2020. They revealed endometritis takes an average of eight years to diagnose. 

The trivialisation of women’s pain must stop. But how?

Language is key in tackling the gender pain gap. One area to consider is research indicating that women and men describe pain differently. Studies suggest women focus on sensory symptoms and use more descriptive language. In contrast, men are more succinct, concentrating on events and emotions. Women’s pain is also often internal, with no visual indicators. This presents challenges for patients, who may struggle to find adequate descriptions to communicate their pain. 

A common method of communicating pain is through the Numeric Rating Scale (NRS), the same 0 to 10 labels I was asked to use. However, a 2021 study by Bullo and Weckesser found the NRS insufficient for communicating endometriosis pain because it is so subjective. When I was bedridden, I guessed my pain was 6.5, but different people have different benchmarks. A 6.5 for me might be 3 or 9 for others. Bullo and Weckesser suggested patients and professionals should use additional tools in describing pain, for example, extending the use of metaphors and similes. 

Patients often compare violent actions to womb-related pain: stabbing, piercing, burning. These powerful visual descriptions may help patients convey the severity of their pain in ways the NRS cannot. But this requires medical practitioners to recognise and appreciate this type of language.

Looking back on my experience, maybe I should have given my pain a higher rating than 6.5. Perhaps I should have used more powerful, visual metaphors. Would it have saved me months of pain and anxiety? I will not know. 

Now, at least, I understand the power of language and the important role it plays in the trivialisation of women’s health. Next time, I will not blame myself for overreacting if my pain is labelled as ‘discomfort’.