Pain can be described as a subjective experience that causes physical discomfort and psychological distress to a living organism. This multidimensional phenomenon can be categorized as “chronic pain” if persistent over three months. In the recent decade, research on chronic pain has become more and more gender-specific, as understanding why people vary in their pain experience is essential for a more targeted and better treatment process. Current literature highlights the “gender pain gap,” defined as women being more poorly understood and mistreated than men’s pain due to systemic gaps and biases in the medical context (“From Heart”). While a significant amount of research has shown that women are more likely to develop many chronic pain forms, in contrast, practically, they seem to be perceived as less trustworthy and emotional while reporting pain. In this article, we will talk about the gender pain gap and potential underlying factors.
Even though women tend to outlive men on average by a couple of years, it has been found that they have a higher illness and pain prevalence (Keogh 2022). Chronic pain conditions like migraines, tension-type headaches, etc., are more frequently seen in women. This article will divide the possible factors shaping this phenomenon into two parts: biological factors and socio-psychological factors. Interestingly, as research accumulated on this topic, the socio-psychological factors outweighed the biological ones. So, let's dive in.
Of course, many biological factors affect how men and women vary in their perception of pain. For example, low testosterone levels have been found in many chronic pain conditions, which may explain why women have a higher pain prevalence as they have lower testosterone levels (Casale et al. 2021). It is also known that menstrual cycles, pregnancies, and oral conception methods affect how women experience pain due to hormone alterations. Some professionals even looked at this phenomenon from an evolutionary perspective and proposed women developed a heightened sensitivity to pain to protect reproductive structures and maintain reproductive success (Keogh 2022). These may all cause a difference in the percentages, of course; however, the biggest issue is the nonresponsiveness of women to many drug treatments because medical research, especially pain research, heavily takes male physiology as the fundamental model. For example, no pharmacological options for treating chronic pain have been developed explicitly for women, and this causes women patients to not “get better” and for the pain to endure, meaning higher prevalence.
The socio-psychological components heavily connect to the attitudes of the professionals towards the patients and, thus, underestimating and undertreating them. The long-coming women's stereotype of being “hysteric,” “hormonal,” “overly sensitive,” and “overexaggerating” portrays them as nontrustworthy (ironic) while reporting pain. Their reactions and complaints are underestimated, which reflects the treatment pathways chosen. For example, women are more likely to be forwarded into a psychological treatment path when expressing their chronic pain (Samulowitz et al. 2018). Women are raised to be more vocal about their physical discomforts compared to men; yes, this backfires when they are not being listened to and when there is no one to take their complaints. These social occurrences contradict the biological knowledge that women are more prone to pain. If there is a higher prevalence, why the undertreatment? The systematic sexism rooted in gender beliefs and expectations has been becoming increasingly a problem for women’s health and well-being daily.
The UK set a great for the world on women’s health goals. The women’s health strategy will be enacted in 2024 and involves commitments around (“First Women’s”):
New research and data gathering
The expansion of women’s health-focused education and training for incoming doctors
Improvements to fertility services
Ensuring women have access to high-quality health information
Updating guidance for female-specific health conditions like endometriosis to ensure the latest evidence and advice is being used in treatment
They have spared the necessary funds to make this happen and are a role model for all countries. Having incoming doctors who start their professions mindful of women’s health and social biases will, in the long run, create a new generation where both halves of the population will be treated equally. Equal treatment for all comes from personalized treatment for every group, and we see that a big action like this is necessary to make a great change in medicine.
What is next? Medical education should be more diversified by adding awareness of biases against different genders, races, and classes. Nonbinary and transsexual medical research should be included in the discussion. The effects of racial and socioeconomic biases should also be researched more in-depth to personalize the best treatment ways and experiences for all people worldwide. Needed funds should be spared for social research about medicine to make it more accessible to all groups of people. The UK started by setting a tremendous role model for the whole world to collectively tackle this issue and many biases among different groups of people. Equity and well-treatment in medicine should be a must above all because nothing is more sacred than one’s health. As Rudolf Virchow, the father of modern pathology, once said, “Medicine is a social science, and politics is nothing more than medicine on a grand scale,” we should not forget that medicine is not only a positive one but a social one. It is from people to people and for people who can not be taught without discussing and unraveling the issues that cause some people to be neglected.
Edited by Bilge Öztürk
Casale, Roberto, et al. "Pain in Women: A Perspective Review on a Relevant Clinical Issue That Deserves Prioritization." Pain and Therapy, vol. 10, no. 1, 15 Mar. 2021, pp. 287-314, https://doi.org/10.1007/s40122-021-00244-1.
"First Women's Health Strategy for England to tackle gender health gap." Government, 20 June 2022, www.gov.uk/government/news/first-womens-health-strategy-for-england-to-tackle-gender-health-gap.
Keogh, Edmund. "Sex and Gender Differences in Pain: Past, Present, and Future." Pain, vol. 163, no. S1, Nov. 2022, pp. S108-S116, https://doi.org/10.1097/j.pain.0000000000002738.
Ross, Charley. "From heart attacks to medical research: the gender pain gap in numbers." The Guardian, 26 May 2023, www.theguardian.com/see-my-pain/2023/may/26/from-heart-attacks-to-medical-research-the-gender-pain-gap-in-numbers.
Samulowitz, Anke, et al. "'Brave Men' and 'Emotional Women': A Theory-Guided Literature Review on Gender Bias in Health Care and Gendered Norms towards Patients with Chronic Pain." Pain Research and Management, vol. 2018, 2018, pp. 1-14, https://doi.org/10.1155/2018/6358624.