Recently I stumbled upon an article saved in my bookmarks since 2015. The article is entitled “Female Pain: Living with an Illness That No One Believes In” this led me on to another similar article from the same online magazine “One Third of Women are Living in Sexual Pain that is Ruining Their Lives” and then finally onto this one “How Doctors Take Women’s Pain Less Seriously”.
I began to think about my own personal experience with the health service in the United Kingdom, and with the upcoming election my Facebook is flooded with meme’s trying to persuade me to “Vote to Save Our NHS” I begin to recount the positive and negative experiences I’ve had with both private and government run healthcare.
While the articles above are interesting, they’re all anecdotal. I have had similar, what I would consider poor, experiences when it has come to my gynaecological and mental wellbeing in the past, but the attitudes of doctors and nurses I have met has varied widely. I decided to look further into whether there is a genuine disparity between men and women’s treatment – and particularly if women’s health is taken “less seriously”.
My initial thoughts where that from a young age women are able to deal with cramps, menstrual blood, mood swings, headaches, nausea and a whole host of other nasty symptoms each month. Every individuals pain threshold is different, but this type of pain is something women become accustomed too, or at least endeavour to self-medicate. I know from my own female family members that women can at times be prone to exaggeration, my mother and grandmother in particular, were always extremely concerned about my well-being almost to the point of an over protective hypochondria – this led me to be able to get quite a lot of time off of school, whenever it took my fancy – but also led to an irritation inside me where-by I built up a surprisingly high pain threshold in order to insist I no longer needed to be fussed over. Every women’s personal health journey will vary greatly throughout their lives – their economic and societal upbringing and the attitudes of their family will play into a women’s individual experience of her healthcare system (for myself The NHS). However, from the statistic’s I have looked at there do seem to be some consistent themes.
The Women’s Health and Equality Consortium (WHEC) suggest “Whilst women live longer than men, they spend more years in poor health and with a disability. One in three women die from cardiovascular disease (similar to men), yet they are less likely to think they are at risk, call for help or attend a cardio rehabilitation programme. Women are more at risk of stroke than men and tend to be more seriously affected, needing long-term care. Women are much more likely than men to suffer arthritis and rheumatism – the most common types of chronic diseases in the UK. Women living in the most deprived areas have cervical cancer rates more than three times as high as those in the least deprived areas. Women living in deprived areas have a lower survival rate for breast cancer 9 and inequalities in rates of breast cancer are increasing. Recorded rates of depression and anxiety are more than twice as high for women than for men. Women and girls in the UK are more likely to have poor sexual health than their European counterparts”. I have deleted the citations in this blog (for purely aesthetic reasons) but they can all be found in the hyperlink at the start of this paragraph). The PDF leaflet goes on to explore other risks to women’s health – such as gender based violence, mental health, pregnancy, PND, and goes on to discuss the barriers women may face to accessing the healthcare they need. One comment I found particularly interesting was as follows:
“Another barrier to accessing care is some health professionals’ lack of cultural competence and effective engagement in terms of responding to the health needs of BMER communities, which affect overall attitudes to women’s care. For example, a lack of competence can include making cultural assumptions or being over sensitive about culture which can lead to professionals not knowing how to intervene appropriately or not intervening at all. Women may also find it difficult to disclose health problems associated with FGM due to fears of being judged and embarrassment. Policy issues and response Health policies that take gender into consideration will improve outcomes for everyone and provide an effective health system that is fit for purpose. It is central to the NHS Constitution and legal obligations (the Equality Act 2010 and Human Rights Act 1998) of heath organisations to ensure everyone receives quality care and that inequality and discrimination is eliminated. This must be done at national and local level. Equal access to high quality services is needed to tackle the health inequalities women and girls face in 56 Independent Living Institute (1998) ‘Violence and disabled women’ 57 Imkaan (2010) ‘Dispelling myths, Speaking Truths’ 58 Bharj, K et al (2008) ‘Addressing ethnic inequalities in maternity service experiences and outcomes: Responding to women’s needs and preferences’ FORWARD (2009) ‘FGM is Always with Us: Experiences, Perceptions and Beliefs of Women Affected by Female Genital Mutilation in London: Results from a PEER Study’ WHO (2004) ‘Gender in mental health research’ Geneva, World Health Organisation relation to their mental, physical and sexual health. High quality maternal health care for pregnant women and mothers is crucial for the life chances of women and future generations, but must respond to all women’s needs and in particular target support to more vulnerable and disadvantaged families. Appropriate care that can meet the needs of all women must include the women’s voluntary and community sector, who are integral to the delivery of health and social care services and are able to provide the services women want and use (such as women only services)”.
An essay from the academic journal PubMed US National Library of MedicineNational Institutes of Health – while concerned with the health system in America was still insightful. The essay was entitled “Gender disparity in analgesic treatment of emergency department patients with acute abdominal pain” Analgesic treatment means “The ability of analgesic or anti-inflammatory drugs to reduce or eliminate signs of pain can provide evidence, which confirms the presence of pain’. The results can be condensed as follows:
“Of the 981 patients enrolled (mean age +/- standard deviation [SD] 41 +/- 17 years; 65% female), 62% received any analgesic treatment. Men and women had similar mean pain scores, but women were less likely to receive any analgesia (60% vs. 67%, difference 7%, 95% confidence interval [CI] = 1.1% to 13.6%) and less likely to receive opiates (45% vs. 56%, difference 11%, 95% CI = 4.1% to 17.1%). These differences persisted when gender-specific diagnoses were excluded (47% vs. 56%, difference 9%, 95% CI = 2.5% to 16.2%). After controlling for age, race, triage class, and pain score, women were still 13% to 25% less likely than men to receive opioid analgesia. There was no gender difference in the receipt of nonopioid analgesia. Women waited longer to receive their analgesia (median time 65 minutes vs. 49 minutes, difference 16 minutes, 95% CI = 3.5 to 33 minutes)”.
Giving a conclusion that there is a possibility of a gender bias in this type of treatment for pain.
So I have delved a little deeper into the more analytical side of women’s pain – although I did find it harder to find many studies that was specific to a UK perspective. I decided to team what I had already found with a more artistic, literary and historical approach to female pain. I found a very explorative text in the online journal The Virginia Quarterly Review (VQR) I found an entry by Leslie Jamison who is an American novelist and essayist, the essay was entitled Grand Unified Theory of Female Pain and is certainly worth a read if you have the time. There were a couple of passages I found compelling the first being a quote from Susan Sontag “Susan Sontag has described the heyday of a “nihilistic and sentimental” nineteenth-century logic that found appeal in female suffering: “Sadness made one ‘interesting.’ It was a mark of refinement, of sensibility, to be sad. That is, to be powerless.” This appeal mapped largely onto illness: “Sadness and tuberculosis became synonymous,” she writes, and both were coveted. Sadness was interesting and sickness was its handmaiden, providing not only cause but also symptoms and metaphors: a wracking cough, a wan pallor, an emaciated body. “The melancholy character was a superior one: sensitive, creative, a being apart,” she writes. Sickness was “a becoming frailty … symbolized an appealing vulnerability, a superior sensitivity, [and] became more and more the ideal look for women.” Jamison explores Sontag’s analysis further by suggesting “–the tricky flip side of Sontag’s critique. We may have turned the wounded woman into a kind of goddess, romanticized her illness and idealized her suffering, but that doesn’t mean she doesn’t happen. Women still have wounds: broken hearts and broken bones and broken lungs. How do we talk about these wounds without glamorizing them? Without corroborating an old mythos that turns female trauma into celestial constellations worthy of worship?
Jamison goes on to discuss “A 2001 study called “The Girl Who Cried Pain” tries to make sense of the fact that men are more likely than women to be given medication when they report pain to their doctors. Women are more likely to be given sedatives. The study makes visible a disturbing set of assumptions: It’s not just that women are prone to hurting—a pain that never goes away—but also that they’re prone to making it up. The report finds that despite evidence that “women are biologically more sensitive to pain than men … [their] pain reports are taken less seriously.” Less seriously meaning, more specifically, “they are more likely to have their pain reports discounted as ‘emotional’ or ‘psychogenic’ and, therefore, ‘not real.’ ”
Of course I downloaded “The Girl Who Cried Pain” and have begun to work my way through the lengthy text. However, even from the outset this academic study seems to suggest that there is in fact a very real difference between the way in which male and females pain is treated at the doctor / patient level and that this may in fact bleed out into society’s interpretation of women’s pain and indeed what a woman will allow herself to suffer through before seeking medical attention. The study goes into great detail discussing aspects I had not even before considered such as the fact that men and women will experience pain differently, that hormonal changes in the body can affect our pain thresholds, there are specific biological and psychological difference that affect how men and women perceive and experience pain and the health system is not consciously taking these into consideration when treating male and females painful conditions. The study then goes on to describe the different ways that men and women cope with pain both cognitively and culturally. About half way through the study the paper addresses the actual attitudes that healthcare providers may take towards women’s pain “Given that women experience pain more frequently, are more sensitive to pain, or are more likely to report pain, it seems appropriate that they be treated at least as thoroughly as men and that their reports of pain be taken seriously. The data do not indicate that this is the case. Women who seek help are less likely than men to be taken seriously when they report pain and are less likely to have their pain adequately treated. This conclusion raises the question of what accounts for this difference in treatment. In light of the apparent lack of objective data supporting lesser treatment of women for pain, a likely explanation is the health-care provider’s attitudes regarding male and female sensitivity to or tolerance of pain and the validity of their self-reports. There are, in fact, data to support the hypothesis of this attitude or bias by healthcare providers”. This quote may help as supporting evidence for the articles which I cited at the very beginning of this blog – the anecdotes in these articles, the experiences I have had, and the experiences of my friends and family all seem to be backed up by this last quotation.
So what conclusions can I draw from these findings? Well, in general – and this goes for both genders we need to take better care of ourselves. Your body is the only one you’re going to get, and needs care and loving attention. I feel there is a lot we can do to keep ourselves healthy, mindful, and in a state of well-being. However this isn’t going to be the case all of the time and we are all going to have to have some medical intervention at some point or another. Considering what I have learnt in my small investigation into women’s healthcare – these are the rules I am now going to attempt to follow for the future.
1. Treat healthcare professionals with respect and make your interactions positive.
If you go into a interaction at a hospital or doctors surgery expecting a poor outcome, you’ll probably receive just that.
2. Be true to the pain you’re feeling.
Don’t downplay your pain for fear of humiliation, for seeming weak, or for a fear of rejection. Answer questions honestly and attempt to really be in touch with your own body and thresholds in order to give accurate information to doctors and nurses.
3. Be Assertive.
If you want more information, if you feel you do not understand what has been presented to you, or are not satisfied with the outcome you must have the confidence to say this and ask for more.
4. Always put your health first and seek a specialist sooner rather than later.
If you feel dissatisfied with the service you’ve been provided always get a second opinion, or seek out a specialist in that area. We don’t think twice about replacing expensive parts on our cars, or buying expensive new technologies – but when it comes to our bodies we always presume free is best, I am not convinced this is always the case.
Around two years ago I had a few different medical issues, in relatively quick succession of each other. I visited by City GP (where you rarely see the same doctor twice unlike some smaller village doctors surgeries) while on the whole I had been impressed with the care and attention I had been given at this facility in the past, on these occasions I became frustrated by what I considered a disinterest in my mental well-being and a lack of acknowledgment of the pain I was feeling – and the impact it was having on my relationships. I wrote a long letter to the surgery detailing my experience – to which this day I have still received no response. In the end I became so anxious about my situation that I used my student overdraft to make an appointment at a Nuffield Health Clinic near my home in Brighton. I was overwhelmed by the level of attention and care I received there and my attentive female consultant was able to resolve my issue in one appointment and give me a lot of information and guidance. It was true in that situation that you really do get what you pay for. It is also true however, that I am no longer in a financial position to be able to do this, and this is the case for many others – leading me to believe that our NHS is in need of a mighty overhaul of attitude – not just funding, or inefficiency, or bureaucracy but its actually methodology towards female patients and their sexual, genital and mental health.
Some other articles I had a look at while writing this blog are listed below: