Why Doctors Still Dismiss Women’s Pain
They hurt just as badly as men, yet a focus on addiction prevention obscures the reality
Elise Cady of Boise, Idaho, went to five different gynecologists before she found a doctor who believed her menstrual symptoms were extreme and deserved proper medical attention.
For six years after graduating high school, Cady suffered debilitating pain during her menstrual cycle.
“I would collapse on the floor from pain,” she said. “I could tell that the pain was coming from my uterus, but there was residual pain everywhere else, too. My legs would cramp up and hurt, my arms would ache, my back would ache.”
She added, “I would rate my pain about a nine.” She says this two months after giving birth to her baby boy.
But her gynecologists kept turning a blind eye. Cady continued to set up appointments, especially when the symptoms became bad enough that she was bleeding throughout the month. She urged her doctors to run tests to find out what was wrong.
For reasons Cady doesn’t understand, the doctors did not even perform an ultrasound. Finally, Cady had taken off the afternoon from her work at a preschool and was on her way to a fifth appointment when her doctor called and canceled the appointment, saying there wasn’t anything she could do.
Cady demanded an ultrasound and got a different doctor at the clinic to take a look at it. They found a cyst on her ovaries, large polyps in her uterus, and endometrial tissue — tissue that normally lines the inside of the uterus but grows outside the uterus instead and often develops into scar tissue.
Cady needed two surgeries to address the problem.
Unfortunately, this one story isn’t unusual. Studies across the country show that women are consistently undertreated for their pain. In “The Girl Who Cried Pain,” law professors Diane Hoffmann and Anita Tarzian at the University of Maryland collected more than 100 studies across the country that demonstrate the bias women battle against when receiving treatment for their pain.
For example, in a study of patients with metastatic cancer, women were about five times more likely to be undertreated than men with similar symptoms. In a study of 366 AIDS patients, women were more likely than men to receive inadequate therapy for their pain. One study on abdominal surgery showed that physicians prescribed less pain medication for women. Another study showed that men were more likely to receive narcotics to treat their pain, while women were more likely to receive sedatives.
Men’s pain is more likely to be perceived as legitimate, and women are more likely to be perceived as hysterical. This phenomenon even has its own name: the “Yentl Syndrome,” based on the 1983 Barbara Streisand movie in which she pretends to be a man to receive an equal education. Women often have to prove that they are as sick as men before they receive equal treatment.
"The Girl Who Cried Pain," however, was published in 2001, and times have changed. Yet Tarzian doesn’t believe we’ve made as much progress as we should have.
Initially, there were some good changes — such as the gender-neutral "rate your pain" signage throughout hospitals. But Tarzian said pain management has now taken a backseat to addressing the widespread addiction to prescription painkillers.
"Undertreating pain is the big problem," Tarzian told LifeZette. "The sex differences exist, but we need to address the bigger problem.
"Pain management now is a lower priority because of painkiller addictions, and that’s a whole other issue. State medical boards were trying to incentivize physicians to treat pain and not be afraid to use opioids, but then people started stealing pain pills, and we had an epidemic of abuse of prescription painkillers that caused a chilling effect on the advancements."
Statistics back this up. New polls from the Kaiser Family Foundation show that 27 percent of Americans report that they or someone they know has been addicted to prescription painkillers. And the new focus on addressing this problem means that people are less worried about undertreating pain — even when there’s evidence of sexism.
Marc Wirtz, an emergency department nurse in Salt Lake City, Utah, has come across patients with painkiller addictions often.
"Physicians and nurses in general are wary when patients come in and demand specific narcotics. It sends up a red flag," Wirtz said.
He said doctors have an Internet database in which they can check to see whether a patient has been recently prescribed some form of narcotic.
"If we see someone who has been at the hospital four, five, six times in the last few weeks, we’ll review the chart to make sure we’re not duplicating orders," Wirtz said. "We don’t want to compound costs, and we want to prevent a potential addiction."
While preventing addiction is necessary and worthwhile, medical professionals are not necessarily aware of the sexism in their own hospitals. But that could be changing. Wirtz said there has been a recent push for medical care professionals to include their patients in the plan of care and validate their concerns instead of making decisions out of earshot of their patients.
"When patients are included, they feel valued, which I think has been missing," Wirtz acknowledged.
Tarzian also believes there is some slow progress in pain management.
"We’re getting better at treating acute pain but not chronic pain," she said. "You have to educate people about their pain and pain medicine and relieve their fears about addiction. It’s not a one-size-fits-all."
For women like Cady, these changes can’t come soon enough.
"Getting someone to believe I was in pain growing up was ridiculous," she said. "That’s why fibromyalgia and other chronic pain disorders have just barely become something that people are recognizing as real."