The Pain Gap: Why is Women’s Pain Not Taken Seriously?

By Darcy Nathan 

I was eleven years old when I returned from school after a sexual education lesson in tears, traumatised. The boys had been removed from the classroom before the girls were informed that we should expect to be in pain, monthly, for the rest of our adult lives upon the arrival of our first period. Afterwards, the boys bragged to us about their extra break time.

I was already aware of the impact menstruation would have on me, but the lesson had felt like more of an ominous warning than a comforting, open discussion about our bodies. In my early twenties, I now have the same sense of impending doom when the horrifying realisation occurs to me that I, one day, must endure agonising childbirth if I want a family of my own.

The relationship between women and pain is an interesting one. Studies show that, globally, women experience more pain over their lifetimes than men. It is the expectation that women will inherently experience pain. This expectation forms the basis of the phenomena of the pain gap. This bias that women are expected to experience pain their entire lives is now deeply embedded into modern medical discourse.

Endometriosis, for example, takes on average nine years of suffering to be diagnosed, often dismissed as painful periods or depression. Women are also 50% less likely to be diagnosed after experiencing a heart attack, which is commonly misinterpreted as anxiety. Pain is self-reported, and so we must decipher why women’s accounts are not believed. A starting point is misrepresentation in clinical trials.

Medical trials are, more often than not, centred around a male ‘norm’, and women are underrepresented. In studies of cardiovascular disease, women only make up around 25% of the sample size. 80% of those who suffer from chronic pain are women, yet 70% of those involved in clinical trials on chronic pain are men. There is also reduced evidence for how drugs interact with our menstrual cycles – women anecdotally discovered the impact of the COVID-19 vaccine upon our cycle before it was ever recognised by medical professionals. 

Initial trials of the active ingredient in Viagra, sildenafil, produced a promising reduction of menstrual cramping, or dysmenorrhea; pain which has been cited in studies to be almost as bad as a heart attack. Funding for the trials ceased, however, as pharmaceutical bodies indicated that dysmenorrhea was ‘not a priority public health issue’. Is it really any wonder that our accounts of pain are routinely dismissed if we are not even deemed important enough to provide funding for?

During the first lockdown, I read about the under-representation of pregnant women in WHO’s data during the SARS outbreak of 2002. Predictably, it was vulnerable pregnant women, such as nurses and carers, who were forced to wait until they were represented in trials before the COVID-19 vaccine was made available to them earlier this year. 

This unquestioned idea of the male as the ‘norm’ routinely puts women’s health at risk. The pandemic illuminated this bias again through the introduction of the vaccine after the AstraZeneca vaccine was reported to have a blood-clotting risk. I myself panicked upon receiving this vaccine. Then I realised that I had been taking the combined pill for two years, with which the risk of blood clots is 100 times higher. 

This was a pill that I had begged my doctor to change numerous times, not only because of the risk to my physical health but my mental health too. I became depressed and severely anxious on the contraceptive pill, but this was dismissed as circumstantial stress, and so I too was misunderstood, overlooked, and ignored.

Birth control is undoubtedly a contentious issue for gender bias in medicine. Currently, the only hormone-free option available to women is the copper IUD, a method for which 17% of women report ‘severe pain’ upon insertion into the uterus. There is currently no set protocol for offering pain relief, such as an anaesthetic, during the procedure.

The diagnosis of hysteria may be obsolete, but the tendency to assume women are exaggerating, or indeed hysterical, prevails. While on the surface this is disheartening, it becomes an acute issue when the well-being of half of the population is at risk due to archaic stereotypes and sub-standard attitudes to research. 

There is no reason for young girls to grow up expecting to endure pain. We must acknowledge the experiences of the women of our generation to end the unnecessary suffering of women for good.