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Gender pain gap: Why women's pain must be taken as seriously as men's

We are all likely to treat people in pain differently according to their sex. Change is urgently needed for more equitable care

In medicine, men's pain is routinely assessed to be more severe than women's. Image: Mohamed Hassan from Pixabay

Gender pain gap
Dr Amanda Williams

If we were to take 100 doctors and nurses and ask them to assess a patient’s pain, we can be fairly sure that a man’s pain would be estimated as higher than a woman’s. Women’s pain is routinely discounted, because of the belief that women exaggerate, or imagine, or make more fuss about their pain than men do. This is the case whether the doctor or nurse is male or female – and it is seen much more widely in Western culture.  

Medical diagnosis and treatment likes certainty, and what the patient says is usually a starting point for examinations and tests. But pain is tricky. It is one of the commonest reasons to go to a doctor, but it does not always have a reason that shows up on tests and examinations. Whether it does or not, the only humane starting point is to listen to the person who complains of pain. 

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This is where beliefs come in. Women are often well aware of what they are up against, hoping to be taken at their word about their symptoms. I cannot count the number of women who have described the dilemma: do they present themselves well dressed, hair tidy and makeup on, calm and articulate, only to be told that “you look fine, so the pain can’t be very bad” – or do they present themselves as they feel, messy and unattractive, to find themselves written off as neurotic?

There are plenty of negative stereotypes to apply to women, and they can pile up too: anyone with a psychiatric history may find her account doubted, particularly if she has a history of substance abuse, since opioids are one of the possible treatments offered for pain. In research studies in America, people from ethnic minorities received poorer assessment and treatment for pain, although to a lesser extent where the clinician was from an ethnic minority.  

In one common disorder, endometriosis, women’s accounts of very painful periods which often start early in their teens, tend to be written off as “just period pain” for many years before they are correctly diagnosed and offered treatment. Where disorders affect both men and women, women are more likely to be asked about stress as a possible cause of pain, even with chest pain that might signal heart problems, and to be offered psychological treatment, where a man with the same complaints is investigated further. Women are asked about being able to do housework as a sign of recovery; men about sports and activities. 

Of course, there are real differences in physiology between men and women, but the expectations we have of men and women in pain do not arise from biological difference, but from norms that take men as the ideal. Men can also suffer from stereotypes, with complaining of pain being seen as ‘weak’, and psychological aspects of pain being disregarded. 

How can the situation improve? This is not just a problem in medical care: we are all likely to treat people in pain differently according to their sex. A study of toddlers in the playground showed that girls who fell over and hurt themselves tended to be cuddled and comforted by the adults present, whereas boys were encouraged to carry on playing without any help. 

More equitable care will come with a more equitable society, across sex, gender, ethnic and other differences. Better understanding of pain for all of us, not only clinicians, will benefit everybody, putting the psychological aspects of pain in context. We should always believe people when they say they are in pain.

Dr Amanda C de C Williams is professor of clinical health psychology, University College London.

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