Perception of Pain in Women

Women are perceived as fragile and hypersensitive. Throughout the 19^th century, women were considered overly emotional and were urged to take tranquilizers to help them complete simple tasks. The idea that women were debilitatingly weak led to the contemporary notion that women exaggerate the severity of pain that they endure. The ramification of the master narrative that all women are frail is that physicians underestimate female pain and treat it less aggressively. This leads women to suffer unnecessary pain, which has both short term and long-term negative psychological and physical effects. 

The preconceived notion that women are the more miserable and emotional gender has strong roots in history. In the 20^th century, people assumed women lacked the mental capacity to manage the hardships of everyday life. Women were twice more likely to be diagnosed with depression than men and were prescribed opiates to treat nervousness. Additionally, women were prescribed “mother’s little helpers,” a class of tranquilizer drugs known as benzodiazepines, when they returned to their domestic roles after World War II. During the 1960s, these drugs were known to treat “effeminate nerves” that emerged from completing mundane chores, like cooking and cleaning. The prescription and advertisement of such potent drugs showcase how women were viewed as fragile and required narcotics to help them accomplish simple tasks (Prewitt).

Female vulnerability in the 20^th century is evident in the pharmaceutical marketing for sedatives aimed at women. Figure 1 is an advertisement for the sedative Butisol, titled “Now She Can Cope.” Fig. 1 depicts a woman tied in a rope by her daughter and with her back turned to the stove. The woman is having difficulty focusing on cooking while caring for her child. She is depicted as mentally incapable of untying herself from a rope that her child playfully wrapped around her. In the fine print, the ad refers to this as an “environmental pressure” that needs an “anxiety” alleviating agent such as Butisol (Prewitt).

Another ad for the sedative Oxazepam, called Serax, is illustrated in Figure 2. The woman in the picture is portrayed as being trapped behind cleaning tools that resemble a dark jail cell. She is biting her nails and is mentally distraught from the “insurmountable problems of raising a young family” (Prewitt). This woman, like many others, requires sedatives to help her “cope with day to day problems” (Prewitt). These pharmaceutical ads demonstrate how women were viewed as feeble and seemed to lack mental strength during the 20^th century. 

These same drugs that were prescribed for anxiety and everyday stress were also used to treat pain originating from pregnancy or menstrual pain, which indicates that physicians at the time viewed these female conditions as a product of nervousness or other psychological conditions. In addition, many women were also prescribed morphine, laudanum, and chloroform, which are strong drugs that were used as tranquilizers during the late 19^th century to treat gynecological conditions (Prewitt). In the 19^th and 20^th centuries, women were highly medicated, whereas today, they do not receive enough medication.  

The assumption that women are weak remains today and influences physicians to underestimate the pain that women endure. In a review of literature on gender bias in pain treatment, 77 articles were found that describe “women with pain can be perceived as hysterical, emotional, complaining, not wanting to get better, malingerers, fabricating the pain, [and] as if it is all in her head” (Samulowitz). As a result, medical professionals are reluctant to believe that women are in pain, which is especially true if women are experiencing “medically unexplained” chronic conditions (Samulowitz). Medically inexplicable diseases include pain without observable or objective symptoms, diagnostic evidence, or organic pathology. Examples of such chronic pain conditions include endometriosis, fibromyalgia, irritable bowel syndrome, painful bladder syndrome, migraine headache, chronic fatigue syndrome, chronic tension-type headache, chronic lower back pain, temporomandibular joint disorders, and vulvodynia (Jackson). These chronic pain disorders affect at least 50 million women in the United States (Jackson). Women suffering from these illnesses typically have a delayed diagnosis, and before they were diagnosed, they were told that they “have a mental health condition or are too concerned about their health” (Jackson). Too often, women are viewed as fabricating their pain, which leads physicians to hesitate to diagnose critical conditions and provide adequate medical treatment for female patients.

Mikaela Conley, author of “What is Vulvodynia?” describes her experience suffering from Vulvodynia, which is chronic pain around the vulva due to unidentifiable causes that lasts for at least three months. Conley had difficulty inserting tampons, wearing underwear, sitting for a long time, and having sex. Vulvodynia interfered with her ability to form intimate relationships and decreased the overall quality of daily life, as it does for many women. Conley sought medical treatment from multiple doctors, but they denied her hardships and failed to offer viable advice and proper treatment. One doctor responded to her complaint by telling her to “drink some wine and take an Advil and just relax” (Conley). Another doctor, before even physically examining the area, told her that he “could cut out the part that hurt or put me on an antidepressant” (Conley). Conley’s physicians were under the impression that she was not actually experiencing pain by advising her to unwind. Furthermore, the second doctor attributed her complaint to a mental health disorder by offering antidepressants, which are meant to treat psychiatric disorders, not physical ailments. Both physicians neglected to prescribe the necessary analgesics or nerve pain medications that Conley needed. Many female patients, like Conley, are denied appropriate treatment because their pain is often attributed to psychological origins or emotional instability.

Women face sexism in the healthcare system and struggle for legitimacy from physicians and other medical professionals. Healthcare providers deny female patients’ credibility of their own physical sensations, which causes women to feel unheard and misunderstood. Eula Biss, a woman who suffered from persistent and debilitating chronic pain, conveys her discontent with physicians telling her “’We have reason to believe you are in pain, even if there is no physical evidence of your pain’” (Biss 30). She realized that her claim of persistent alone was not enough for physicians to believe her because they needed more ‘substantial’ proof. This deepens stress, frustration, and makes women less likely to present future issues to physicians. Thus, a damaging cycle is created which hinders women from accessing the quality healthcare they need. Relatedly, psychiatrist Dr. Dori Laub reveals the detriment of a person dismissing the testimony of a trauma survivor. He conveys that “the absence of an empathic listener…an other who can hear the anguish of one’s memories and this affirm and recognize their realness, annihilates the story” (Laub 68). Similar to how survivors need a witness to their experience, patients also need physicians to witness their narrative of illness. When physicians fail to acknowledge females’ concerns about their pain, their stories go unheard, which results in insufficient healthcare for women. Joe Fassler exhibits a prime example of the effects in his article How Doctors Take Women’s Pain Less Seriously.

Fassler describes how his wife’s severe pain was overlooked by many healthcare providers in the emergency department. His wife, Rachel, was suffering from severe abdominal pain and told the triage nurse that her pain was an eleven on a scale from one to ten. The nurse responded by patting her head and saying, “you’re just feeling a little pain, honey” (Fassler). After they waited hours, the attending physician approached them without introducing himself, asked a few questions, and left without performing a physical examination. Only after a different attending physician began her shift was Fassler able to speak to her about Rachel’s symptoms. After an ultrasound and a CT scan, they found that Rachel had an ovarian torsion. An ovarian torsion is a surgical emergency that causes excruciating pain due to the ovary twisting around other tissues that maintain the ovary’s position. If untreated, as in Rachel’s case, symptoms include nausea, vomiting, obstruction of blood flow to ovaries, and ovary death. In Rachel’s situation, because she was treated so late, her ovary could not be saved, and an oophorectomy was her only option. This distressing experience left Rachel and many of her female friends in fear of coming across as melodramatic during times that emergent care is critical. Rachel still has nightmares about the agonizing event to which she attributes to “the trauma of not being seen” (Fassler).

Unfortunately, healthcare providers in the emergency department frequently diminish women’s narratives of illness. An experiment conducted on the treatment for acute abdominal pain presented in the emergency department illustrates the gender inequality in the emergency healthcare system. The results of the study indicate that women wait longer in the emergency department to receive any type of analgesic and are prescribed less pain killers than men. The study found that “Women were less likely to receive any analgesia, [a] difference [of] 7%, and less likely to receive opiates, [a] difference [of] 11%” (Chen). Women also had to wait an average of 16 minutes longer than men to receive analgesia. In addition, when women and men reported the same pain score, women still received lower triage scores. The outcomes of the experiment suggest that women are treated less aggressively for their pain despite equal reported pain levels (Chen). Because women are perceived as overexaggerating their pain, caregivers underestimate their conditions leading to a low priority triage and ultimately delayed and insufficient treatment.

            The consequential inadequate treatment for chronic pain has long term physical and psychological effects on patients. According to a study in the medical journal Pain Medicine, chronic pain is associated with “increased rates of major depressive disorder, suicidal ideation, and suicide attempts” (Fine). Chronic pain also disrupts cognitive processes, and may result in impaired memory and anxiety. In addition, common physical impairments include sexual dysfunction, restless sleep, and hypertension. Side effects of prolonged chronic pain interfere with everyday functions and decrease the overall quality of life. However, these troubles can be significantly improved if managed by opioids and other analgesics (Fine). If physicians provided women the pain medication that they need to improve their quality of life, many women would not have to suffer as much as they do from chronic pain (Jackson). 

Overall, the master narrative that women are frail and complaining has detrimental implications in the healthcare system. In the 19^th and 20^th centuries, women were highly medicated because they were seen as lacking the mental capacity to complete simple daily household chores. This led to the contemporary notion that women are too weak to handle pain and are consequently perceived as dramatizing their pain. Doctors maintain this bias as well, resulting in less effective medical care for women suffering from both acute and chronic pain. Prolonged untreated chronic pain can have lasting adverse physical and psychological effects on women, which can be prevented by the prescription of appropriate narcotics. To reduce the distress women experience from serious chronic illnesses and acute pain, it is imperative that physicians abandon the sexist notion that women are overemphasizing their pain. Physicians and other healthcare providers must witness women’s narratives of illness to treat them more effectively and help them live healthier lives.

 

 

December 12, 2019

 

Works Cited

Biss, Eula. “The Pain Scale.” Harper’s Magazine, June 2005, pp. 25–30.

Chen, Esther H., et al. “Gender Disparity in Analgesic Treatment of Emergency Department Patients with Acute Abdominal Pain.” Academic Emergency Medicine, vol. 15, no. 5, 2008, pp. 414–418., doi:10.1111/j.1553-2712.2008.00100.x.

Conley, Mikaela. “What Is Vulvodynia?” BBC Future, BBC, 26 July 2018, www.bbc.com/future/article/20180725-the-health-condition-vulvodynia-is-painful-and-misunderstood.

Fassler, Joe. “How Doctors Take Women’s Pain Less Seriously.” The Atlantic, Atlantic Media Company, 4 Nov. 2015, www.theatlantic.com/health/archive/2015/10/emergency-room-wait-times-sexism/410515/.

Fine, Perry G. “Long-Term Consequences of Chronic Pain: Mounting Evidence for Pain as a Neurological Disease and Parallels with Other Chronic Disease States.” Pain Medicine, vol. 12, no. 7, 2011, pp. 996–1004., doi:10.1111/j.1526-4637.2011.01187.x.

Jackson, Gabrielle. “Why Don’t Doctors Trust Women? Because They Don’t Know Much about Us | Gabrielle Jackson.” The Guardian, Guardian News and Media, 1 Sept. 2019, www.theguardian.com/books/2019/sep/02/why-dont-doctors-trust-women-because-they-dont-know-much-about-us.

Laub, Dori. “Bearing Witness, or the Vicissitudes of Listening.” Testimony: Crises of Witnessing in Literature, Psychoanalysis, and History, by Shoshana Felman and Dori Laub, Routledge, 1992, pp. 57–74.

Pam. “Mother’s Little Helper: Vintage Drug Ads Aimed at Women.” Go Retro!, Aug. 2014, www.goretro.com/2014/08/mothers-little-helper-vintage-drug-ads.html.

Prewitt, Taylor. “Take Some Pills for Your Hysteria, Lady: America’s Long History of Drugging Women Up.” Vice, 28 Apr. 2015, www.vice.com/en_us/article/gqmx9j/here-lady-take-some-pills-for-your-hysteria-253.

Samulowitz, Anke, et al. “‘Brave Men’ and ‘Emotional Women’: A Theory-Guided Literature Review on Gender Bias in Health Care and Gendered Norms towards Patients with Chronic Pain.” Pain Research and Management, vol. 2018, 2018, pp. 1–14., doi:10.1155/2018/6358624.