During passing period, junior Peggy Ferguson lies down in the nurses office. She often experiences period cramps that she says can feel debilitating and has noticed that people, men in particular, are not always understanding. "Men act like women are acting dramatic when it comes to pain, but they haven't even experienced it," Ferguson said. Photo by Matteo Winandy
By Juliana Stimac
Kate Carté was months along in her pregnancy when she realized something was wrong.
She met with her OB/GYN to share her worries, but instead of addressing her concerns, her doctor dismissed her entirely.
“He came across as very paternalistic as if he knew my body better than me and when things with the birth started to get a little bit more complicated in the days leading up to it, he didn't really want to listen to my symptoms,” she said. “At one point, he turned to my husband and said, ‘well, she's really tired, isn't she?’”
After meeting with her doctor, Carte was shocked and offended to learn that he had told a nurse she was difficult to work with, simply because she was adamant something was wrong.
“I got labeled as the problem woman,” she said.
In the end, Carté suspicions were right and there were complications with the pregnancy.
This is not an isolated incident. Carté is one of thousands of women whose pain is dismissed because they are believed to be overreacting. Several studies have shown that gender plays a large role in medical diagnosis.
One such study, conducted by the University of Miami, tested gender bias in medical diagnosis by showing non-clinician participants videos of real people, varying in gender, with real shoulder injuries. Despite the participants being non-clinicians, they still reflected subconscious biases that would be present in doctors.
"If you share characteristics with a person in pain, you have more of the pain circuitry in your own brain light up."
When participants were shown videos of women with the same level of pain as men, the women were thought to be having lower levels of pain.
“What we found is that once we controlled for those facial expression differences, men were actually rated to be in more pain than women at the same level of pain and facial expression intensity,” the author of the study and University of Miami Assistant Professor of Psychology, Elizabeth Reynolds Losin, PhD, said. “What that kind of suggests is that the pain behaviors of women are being discounted because for every unit of increase in facial expression, a man is thought to be in more pain than a woman.”
Losin speculates these results are partially attributed to the social expectation that men are supposed to be more stoic than women. She also furthered this study by including another round where participants thought of a possible course of action for the patient.
“So not only were men perceived to be in more pain than women when they had the same pain facial expression, but psychotherapy was judged as more effective for a higher proportion of women than men,” she said. “That suggests that these non-clinicians at least believed that the origin of women's pain might be more psychological, whereas the origin of men's pain might be more physiological.”
These kinds of implicit biases are hard to erase and the fact that some of the treatment differences result from said subconscious biases raises the question of how this can be worked on.
“If you share characteristics with a person in pain, you have more of the pain circuitry in your own brain light up,” Losin said. “That might motivate you to treat them more or be more accurate at predicting or understanding how they're feeling.”
When it comes to pain that is unaccounted for, many women speak about Intrauterine Devices (IUDs) and how painful insertion is despite being told it would be “only uncomfortable.” Dr. Marianne Ebrahim, an OB/GYN at the Women’s Health Specialists of Dallas, specializes in this and explained that her clinic uses certain types of anesthesia to aid with dilation before the procedure.
“Some women will need what we call a cervical block [a local anesthesia injected to help with pain during the procedure] for the IUD,” she said. “Some women do not need that, so we talk about that as a pain control option.”
This access to pain control is not universal though and when women have an IUD insertion procedure, it can be described as horrifying pain if there is no medication specialized to their needs.
"I think in general it’s good to find somebody who you trust. Now I’m much more selective about the doctors I see."
Ebrahim said she evaluates several factors such as whether someone has given birth before and their pain tolerance in order to help manage pain during procedures.
Although her experience with her OB/GYN was not a positive one, Carte saw it as a learning opportunity.
“I think what it did was it made me say if this doctor isn’t listening then I’m going to get a different doctor,” she said. “I think in general it’s good to find somebody who you trust. Now I’m much more selective about the doctors I see.”
To avoid situations like Carte’s in the future, Losin says in the short term it is important to empower women to go to several doctors and get multiple opinions to ensure that their health is not risked by biases. However, the long term solution, recommended by Losin, involves diversifying the medical field to account for similarity and how it positively affects treatment.
“Increasing the diversity of the physician workforce to allow patients [to have] a clinician who shares their demographics is beneficial,” she said.
Ebrahim agrees and says that empathy plays an essential role in ensuring women’s pain does not go unnoticed.
“I think being a woman and going through the exact same thing that my patients go through makes me a little bit more empathetic,” she said. “I don’t need the big movement to address all that with my patients. My patients are my family.”