/ 3 October 2017

Mind the gender pain gap

Is it possible then that they underestimate women’s pain as a result of this “attractiveness” bias?
Is it possible then that they underestimate women’s pain as a result of this “attractiveness” bias?


As with pay, opportunities and promotions, women get short shrift when it comes to their pain being taken seriously. Women in pain get less treatment, wait longer for medical attention and generally get infantilised about their own welfare.

From an early age, women are taught to observe basic gendered social codes — even at their own expense. Be polite. Wait your turn. Don’t call attention to yourself.

But with physical pain, those codes evaporate — the body has a loud, stark way of asking for attention.

The “gender pain gap” has a number of serious consequences. Women in acute pain are left to suffer for longer in hospitals and they are more likely to be misdiagnosed as having mental health problems — even when clinical results show their pain exists. Research shows that women are consistently allocated less time than men by hospital staff because men’s complaints are seen as more authoritative and rooted in logic.

Women’s suffering has long been the source of conjecture and ridicule; it is minimised and ultimately coaxed into silence.

In a 2001 study in the United States, The Girl Who Cried Pain: A Bias Against Women in the Treatment of Pain, published in The Journal of Law, Medicine & Ethics, Diane E Hoffmann and Anita J Tar identify ways gender bias tends to manifest in clinical pain management. Women are “more likely to be treated less aggressively in their initial encounters with the healthcare system until they ‘prove that they are as sick as male patients’ ”, the study concludes — a phenomenon called the Yentl syndrome.

This syndrome is the different protocols medical personnel follow when treating women and men for heart attacks. Medical research has focused primarily on the symptoms of men’s heart attacks, and many women have died as a result of misdiagnosis because their symptoms often present differently.

The name is from the 1983 film Yentl — adapted from an IB Singer story and starring Barbra Streisand. The main character has to masquerade as a man to get an education.

The phrase was coined in 1991 by Dr Bernadine Healy, in The Yentl Syndrome, published in The New England Journal of Medicine.

Healy, a cardiologist and the then director of the United States’ National Institutes of Health, cited coronary care as a particularly telling indicator of Yentl syndrome. A woman has to experience a full-scale heart attack before she can get treatment equal to a man’s.

One reason for this disparity may be that doctors see women as being more irrational than men, and therefore dismiss their complaints about pain as being all in their heads, rather than physically manifested.

In the 1982 study Women with Pain, published in Chronic Pain: Psychosocial Factors in Rehabilitation, J Crook and E Tunks found that women with chronic pain are more likely to be misdiagnosed with mental health conditions than men, because doctors dismiss women as hysterical. On the other hand, when men say they’re in acute pain, doctors take their pain as having a “legitimate” source.

Another disturbing trend medical research has found is that the more “attractive” medical staff perceive a patient to be, the less aggressive treatment they receive.

In the 2016 research paper Beautiful Faces in Pain, Thomas Hadjistavropoulos found that, because of a “beautiful is healthy” stereotype, doctors assume people who look “better” are healthier and require less treatment. This can have disastrous results for people presenting with symptoms that may not manifest physically or that require MRIs or CT scans.

Because of sexist staffing hierarchies, especially in a field in which men are perceived to be more competent, men are more likely to be the ones making decisions about patients.

Is it possible that they underestimate women’s pain as a result of this “attractiveness” bias?

The disinclination to take women’s pain seriously is not new. It is deeply rooted in the history of modern Western medicine. Diagnoses of hysteria, a remnant of Victorian-era medicine, attributed many complex women’s health issues to psychological disorders.

There are innumerable women’s stories of how pain, including menstrual cramps and even pain in childbirth, was dismissed as fabricated or exaggerated.

The medical fraternity has long prided itself on providing impartial care, based on its reliance on scientific fact. But researchers and activists suggest that sexism may be perpetuated in hospital wards and operating rooms just as much as anywhere else in society.

Kiri Rupiah is the social media editor of the Mail & Guardian