Women's Health Matters: Pain and Prejudice

Pain and Prejudice by Gabrielle Jackson

Allen & Unwin

Pp. 321

Subtitled ‘A Call to Arms for Women and Their Bodies’, this book focuses on how women have been badly treated by the medical profession in the ‘Western World’ (there are many studies, figures and reports, all from the UK, the USA, Australia and New Zealand) and suggests that the times are ripe for revolution. It centres on the fact that medicine was traditionally a male profession and that the male was considered the default, so the difference in women was barely acknowledged let alone appreciated. In a similar line to that taken by Caroline Criado Perez in her book, Invisible Women: Exposing Data Bias in a World Designed for Men, Jackson argues that women are being ignored at best and killed at worst due to this gender bias in medicine.

In general women live longer than men, but they are in more pain. They are not taught to know their bodies or talk about their ailments; they are meant to nurture and support others before themselves. Women aren’t accustomed to discussing ‘female ailments’ – menstruation, menopause and sexual pain are still relatively taboo topics. Many women can’t identify their reproductive organs on a diagram and are certainly not meant to talk about them, as it is considered shameful. An influential study by Melissa Parker on Australian girls found that 93% of them experienced some period pain. About 20% experience severe pain, 24% say their period interferes with four out of nine life activities, and 26% miss school because of pain. “So a quarter of girls are missing school because of pain, and nobody thinks it’s a problem?”

When women demand attention, over their health or issues of equality, they are often labelled as hysterical, and “As an insult, ‘hysterical is still disarmingly effective.” Yet, when men present with the exact same symptoms, it is called shellshock or PTSD. Traditionally medicine was a male profession, and women are often not believed about their own health. In the late nineteenth and early twentieth century, “medicine became an elite profession and took over from religious institutions as the primary enforcers of the social roles of women.”

Because the default case study for all ailments is male, “We assume that the ways in which women are different from men must be the ways in which women are inferior or broken or diseased when in fact it might be that women are just different.” Symptoms of heart attacks are different in women and often misdiagnosed. A World Health Organisation report explains, “It has traditionally been thought of as a man’s disease which has led to deadly consequences for women – in 2004, 7.4 million women over 60 years of age died of cardiovascular disease compared with 6.3 million men.” Stress is a factor in heart disease, but women are often dismissed as suffering from nothing but anxiety when men who present with the same symptoms are diagnosed with heart disease.

Before 1993 there was no legal requirement to include women in clinical trials 

Many clinical tests only use men in their trials, which can prove fatal to women. In 1993, the US Food and Drug Administration and the National Institutes of Health mandated the inclusion of women in clinical trials. Before then, trials were routinely carried out on men only, including: a twenty-year longitudinal study (began in 1958) to explore whether taking an aspirin every day could reduce the risk of heart disease (conducted in 22,071 men and no women); a 1982 trial looking at whether dietary change and exercise could help prevent heart disease (conducted in 13,000 men and no women), and even a trial in the 1960s to investigate whether supplementation with oestrogen was an effective preventive treatment for heart disease (conducted in 8341 men, and no women).

Women generally experience more chronic pain than men – they suffer pains that cannot be seen, so they are often discounted, and pelvic pain is “also beset by stigmas and taboos that make it difficult for women to talk about their sex organs or anything related to them.” When women are believed about experiencing pain, they are often thought to be exaggerating. “Even female doctors, after training and working in the heavily masculinised medical culture, can view this language as confronting and histrionic.”

Women suffer more chronic pain than men

There are several overlapping pain conditions and women who suffer from one are likely to also suffer from others. These include endometriosis; vulvodynia; fibromyalgia; chronic fatigue syndrome/ myalgic encephalomyelitis; interstitial cystitis/ painful bladder syndrome; temporomandibular joint disorders; irritable bowel syndrome; chronic tension-type headache; chronic migraine and chronic low back pain. “Chronic pain conditions aren’t conditions that kill us but they radically alter our opportunities to reach our full potential in life… Pain doesn’t actually kill people – it keeps women in the home and out of work, which has no effect upon the power structures of society, providing no incentive for action.”

Doctors don’t really want to see patients who are difficult to diagnose and harder to fix as it looks bad for their figures and solved statistics: they even call them ‘heart-sink patients’. Women are aware of this stigma, and when they are told they have medically unexplained symptoms, anxiety, depression or are disbelieved, they can move from doctor to doctor in order to find a diagnosis or treatment relief. “In an exasperating development, ‘doctor-shopping’ has come to be seen as an indicator that pain is made up, rather than a result of pain doctors won’t believe.”

Women’s pain is not treated as seriously as men’s pain, and Jackson suggests that women should not simply accept this, but educate themselves about their bodies and demand that they be treated with equal funding and respect. It would be a brave and/or stupid person who would argue with that.