Doctors Don’t Take Women’s Pain Seriously
And it might be your fault. Yes, yours.
Out of all the systematic health inequalities people face in our society, one of the least-acknowledged is that health care providers routinely under-estimate and under-appreciate women’s pain.
Yes, of course patients tell doctors how much pain they’re experiencing. But even so, doctors have to make a judgement as to how expressive the patient is regarding their pain (does “excruciating” mean the same thing coming from person A as it would from person B?) and then make a second judgement about to how to treat the level of pain that they estimate their patient has.
Male doctors underestimate female patients’ pain more than female doctors do, but female doctors aren’t free of this bias themselves. Counterintuitively, more experienced physicians are more prone to this bias.
The same bias appears in the general population– people tend to underestimate how much pain women are feeling, relative to how much pain they express.
It has been suggested that having more female pain specialists would help– and it presumably would, given that most chronic pain sufferers are women. But remember that not only are female doctors not free of sex bias themselves, but most pain management decisions aren’t actually made by pain specialists.
Now, pain is very subjective and one’s perception of pain can be influenced by culture. That said, while there hasn’t been a lot of international research on this issue, it does extend to the UK, at the very least.
Attempts to identify the cause of sex disparities in pain treatment have mostly focused gender stereotypes, and have occasionally veered into some rather speculative sociological theories. But there’s one gender stereotype that probably does contribute to this disparity, and it’s one that you are very likely guilty of perpetuating.
The myth that women have a higher pain tolerance than men is probably a contributing factor here
There’s this pervasive myth that women have a higher pain tolerance than men, because they have to go through childbirth. I don’t know exactly how pervasive this myth is; there don’t seem to be any studies on it, but anecdotally many people seem to have bought into it. And there are a few reasons why you shouldn’t.
First, women can’t do anything to escape the pain of childbirth once it starts– other than ask for painkillers, which they often do– so the fact that they endure childbirth says nothing about their pain tolerance.
Second, women have a higher pain tolerance during labor, apparently due to a massive spike in endorphin production in the brain. That isn’t indicative of their pain tolerance at other times.
But mainly, you shouldn’t believe that women have a higher pain tolerance than men because a simple google search would bring up literally dozens of studies showing just the opposite: men have a much higher pain tolerance and lower sensitivity to pain than women.
Despite the cultural influences on pain, this gender difference is seen in at least some non-Western cultures, suggesting a biological cause. And to make matters worse, women often get less effect from painkillers than men do– but they’re no less prone to side effects, so simply giving them higher dosages isn’t always feasible.
Seriously, scientific findings are rarely more clear-cut than this.
This leads us to a very straightforward, non-sociological explanation for why women’s pain isn’t taken seriously. Doctors get to examine their patients and see what kind of condition their body is objectively in. In general, women are healthier than men. More specifically, men are more prone to do dangerous, potentially harmful things both for work and for pleasure.
So, imagine you’re a doctor and you’ve noted that, in general women complain of more pain than men despite having less damage to their bodies. There are two possible explanations for this.
First, it may be a gender differences in how people talk about pain. Maybe women tend to overstate their pain and men tend to understate it.
Second, women may be more sensitive to pain than men are. This is the correct explanation, but for your entire life, people have been telling you that actually, women have a higher pain tolerance than men, because childbirth.
Sure, you learned otherwise in med school, but let’s be honest: people only recall a fraction of what they learned in school, and that fraction goes down over time.
Meanwhile, you keep hearing that women have a higher pain tolerance than men, and even though it isn’t coming from a credible source– just random people you know– people are prone to believe things that get repeated over and over, even if they really should know better.
Now, I’m not saying this is the one and only cause of the sex disparity in pain treatment. Negative gender stereotypes about women probably contribute. Maybe an excessive concern about overdosing female patients on painkillers contributes as well. But I think it’s indisputable that pervasive misperceptions about the relative pain tolerance of men and women have to contribute here.
So you should stop saying that women have a higher pain tolerance than men. If anything you should endeavor to set the record straight. But the real question here is, why did people ever spread this myth when it would have been so easy to learn that it wasn’t true?
Don’t ever think you’re smarter than the truth
All it would have taken to learn the truth about sex differences in pain experience is a simple google search. Most people don’t do this when they hear questionable claims being made, and they should. But for many people, there’s also some motivated reasoning at play here.
Saying that women are actually in some way tougher than men feels like a good thing to do. It’s anti-stereotypical. It sounds progressive. It can be tempting to treat this consideration as more important than the question of whether it’s true.
At this point I should mention that African-Americans suffer the same bias in pain treatment: physicians routinely underestimate and under-treat their pain. This has been squarely blamed on a pervasive implicit belief that Black people have a higher pain tolerance.
Now, most people will immediately recognize that the belief that Black people have a higher pain tolerance is bad and harmful, even though it’s a “positive” stereotype. That same belief regarding women is often mistaken for a good thing to believe– but note that it has the exact same effect whether it’s stereotypical or anti-stereotypical. Women and African-Americans both suffer from having their pain under-treated.
You might reasonably ask, “Well, how was I supposed to know that saying that women have a higher pain tolerance than men was going to contribute to under-treatment of women’s pain?” That’s a good question, and my answer is that actually, that connection isn’t obvious and I would not have expected you to make it.
The takeaway here should be that misinformation is likely to cause harm in ways that are non-obvious. The truth should be treated as inherently good important and valuable, because people use information to make decisions, and accurate information will help people make better decisions.
A heavy burden of proof must always lie with the person who supports spreading misinformation. Never think you are smarter than the truth.
If there is one thing I want you to take away from this article, it is this: google everything you hear to see if it’s true, and then whatever you find, tell the truth. Doing otherwise is likely to cause harm in ways you can’t easily anticipate.