The gender pain gap is alive and well

In 2001, the Journal of Law, Medicine & Ethics published an article, The Girl Who Cried Pain: A Bias Against Women in the Treatment of Pain, by Diane Hoffman, a law professor at the University of Maryland in Baltimore. Summing up her research findings, Professor Hoffman coined the now oft-cited phrase, the ‘gender pain gap’.

What is the gender pain gap?

Women are far more likely than men to suffer chronic pain. Yet, despite that, multiple studies indicate that gender stereotypes play a role in the treatment of women for pain compared to men, a bias ingrained into medicine for centuries.

An infamous historical example was the case of a woman from Liverpool, known only as J.S. In 1807, J.S. died aged 77 following years of uterine pain. Every doctor she had consulted failed to diagnose the cause. However, a post-mortem revealed she suffered from extensive pelvic and abdominal damage. Despite that, one of her doctors was unconvinced this was serious enough to account for her reported degree of pain. Believing that her agony was exacerbated by ‘nervousness’, he offered the posthumous diagnosis of ‘hysteralgia’. Chosen for its association with ‘hysteria’, this term was adopted and perpetuated by the medical profession for cases of unexplainable uterine pain.

As a label, hysteralgia may have fallen from favour in medical circles, but its sentiment certainly continues. In November 2022, Reckitt Benckiser, manufacturers of painkillers such as Nurofen, published the Gender Pain Gap Index Report, a survey of more than 5,000 men and women about their experiences and perceptions of pain. The report paints a clear picture:

• 50% of women reported a lack of support from their GPs when asking for help for pain, compared with 36% of men.
• 56% of women described feeling ignored or dismissed as ‘emotional’. That compares with 49% of the men surveyed.
• 63% of women said they felt men’s pain is taken more seriously due to “gender discrimination by healthcare professionals”.

And the reported problems were not limited to treatment by the medical profession. One in four women surveyed said no one generally took their pain seriously, compared to less than one in five men.

Yentl syndrome

These results mirror the findings of Professor Hoffman, who, more than two decades on, has co-authored a follow-up paper, The Woman Who Cried Pain: Do Sex-Based Disparities Still Exist in the Experience and Treatment of Pain?

With greater diversity awareness than twenty years ago, Professor Hoffman was, it seems, hoping to find progress. Alas, not. Interviewed by Good Health, she refers to Yentl syndrome, where women are misdiagnosed and poorly treated unless their disease or symptoms conforms to that of men. “Yentl syndrome still exists and women are still treated less effectively than men in their initial encounters in the healthcare system, having to prove that they are as sick as male patients.”

As an example, Professor Hoffman cites a study showing that following heart bypass grafting, women are frequently given sedatives as there is a perception they are anxious. Men, on the other hand, receive more appropriate and stronger pain relief.

“I think treatment of women for pain may have improved in the past 20 years in some institutions where it was made a priority but there are still many places where it is a problem and there is still disparity in the way women and men are treated,” she said.

Professor Hoffman also points to a study published in 2015 in the journal Pain Medicine. An exercise where medical trainees were shown avatars, identical apart from their sex, produced worrying findings. “A third of the trainees had stereotypical attitudes that women’s pain has less of an impact on their work, and that antidepressants and counselling were appropriate treatments — yet again a woman’s pain was seen to be psychological, and that’s troubling.”

A perfect storm

Worrying gaps in medical knowledge combine with damaging cultural narratives about women’s pain to create a perfect storm. This is truly worrying, particularly when it so often results in women delaying seeking help.

The Government’s Women’s Health Strategy, published last year, suggests that medical education, improved research, and access to information and support are all high on their agenda. But change really cannot come soon enough.

A recent glimmer of hope came from Professor Kamila Hawthorne, the new chair of the Royal College of General Practitioners. Commenting in the Daily Mail on the Gender Pain Gap Index Report, she said:

“It’s clear from these survey results that a significant number of women do not feel as though they have been taken seriously by the NHS and it’s important this is recognised and addressed.

“Women’s health is a priority for the RCGP and we’ve worked with partners, including the Royal College of Obstetricians and Gynaecologists and Faculty of Sexual and Reproductive Healthcare to develop educational resources to support healthcare professionals deliver the best possible care to women.”