The Gender Pain Gap: Not in Your Head, Just Ignored

Medical misogyny doesn’t mean doctors are out there hating on every woman that walks through their door. Medical misogyny refers to how many doctors can apply evidence-based methods of diagnoses and treatment based on male biology, to individuals with female biology. This isn’t to vilify doctors, as many would tell you that they got into the field to help people- unfortunately, they were really only taught about one half of the population and told to apply it to the other half. 

I want to first make a note that I will be using the terms women and folks assigned female at birth (AFAB) interchangeably, but that is not to suggest that gender and sex are one in the same, as we know that isn’t the case. Simply that, even when used in a scientific context, the term “female” (when referring to human beings) can often feel dehumanising. 

Sex and gender each play a role in the marginalisation of women’s health, for instance, on a biological cellular level (sex), female physiology will affect the way a drug is metabolised in the body. Another way this plays out on a sociocultural level (gender), classic stereotypes of women being the more “emotional” gender often lead to complaints of pain being minimised or entirely dismissed. 

Stroke, cancer, diabetes and heart attacks are among the many health issues that are under-diagnosed and undertreated in women. A Danish study revealed that for chronic medical illnesses, it takes on average 4 years longer to diagnose women than it does men. The same study revealed a 2 year delay in cancer diagnoses for women. Factors such as gender biases in the healthcare system, the underrepresentation of AFAB folks in research, and a general tendency for symptoms to be dismissed as “stress-related”, all contribute to these lengthy delays. It’s not hard to imagine in these cases of chronic illnesses the knock-on and devastating physical impacts a delayed diagnosis could have on a person, let alone their chances of survival. 

A whopping 80% of drugs pulled from the market are due to side effects on women, a government accountability study revealed. Do you know what it takes to even get a drug on a pharmacy shelf? It’s a meticulous, expensive and a time-consuming 5 step process; from discovery and development > preclinical research involving lab and animal testing > human clinical trials > regulatory review by the TGA (Australia), FDA (USA), EMA (EU) > and finally, continuous post-market safety monitoring to ensure the public’s health and safety. This process often takes 10-15 years- so to think that negative side effects on women were only discovered after a drug was released is kind of…diabolical.

But how did this even happen? Because women weren’t involved in the trial process of these drugs. Exclusively male cells were used during lab testing, male animals were used during the animal testing phase, and the human clinical trials? Participants were overwhelmingly male as well. It wasn’t until the 1990s in the US where it was finally mandated for women to be included in medical research studies. So much of what we know today is still based on male and AMAB (Assigned male at birth) physiology.

When did this start?

The prescription of Thalidomide to prevent morning sickness in pregnant women during the 50s and 60s caused severe birth defects in thousands of children. The drug had been deemed safe in pregnancy, despite never being tested on pregnant women. Additionally, by the 70s, the effects of the drug Diethylstilbestrol (DES), a synthetic estrogen given to pregnant women to prevent complications such as miscarriage, was found to cause uterine abnormalities, fertility issues and increased the risk of certain cancers in the female children of those who took the drug throughout their pregnancy. 

In 1977, in a bid to protect fetuses, the FDA implemented strict guidelines that strongly pushed for all women of childbearing age to be excluded from clinical trials (at least in the early trial phases). However, what certainly might’ve protected pregnant folk and their unborn children then, has significantly impacted women’s healthcare today. The scramble to catch up to the effectiveness of men’s health is on-going. 

THE GENDER PAIN GAP 

The “gender-pain gap” is a term coined by Diane Hoffman to describe the way women’s pain is overlooked in healthcare. The belief that women are over dramatic and emotional (thank you ancient Greece for starting that rumour), combined with the general expectation that discomfort is a ‘normal’ part of a typical sexual experience or menstrual cycle, has often meant patients were told they must be exaggerating when reporting severe debilitating symptoms. 

This is one of the major reasons conditions like dyspareunia or endometriosis have gone undiagnosed for decades and why many women report having doctors encourage them to have a glass of red wine or to get pregnant to alleviate pain symptoms (which is also a total myth about endometriosis). One in 7 Australian females will be diagnosed with endometriosis, yet most will wait up to 10 years for such a diagnosis- the impact can be huge. Many women and AFAB folks report a significant financial, mental, and physical toll in the lead up to a diagnosis- the high cost of booking multiple appointments with practitioners and specialists, taking time off work to attend appointments, feeling invalidated or gaslit by healthcare professionals, feeling misunderstood and alone, and all while the painful symptoms persist. 

Sex and gender differences also play a major role in late diagnosis of conditions like Alzheimer’s disease and Autism Spectrum Disorder (ASD). Early detection can make a profound difference to a person’s quality of life; likely for those with ASD (this is up to the individual), and certainly for those with Alzheimer’s. 

Women make up two thirds of those living with Alzheimer’s, yet the disease is rarely detected in its early stages for women and AFAB folks. Research states that females typically demonstrate stronger verbal memory than males throughout their lives, and are therefore able to pass these early verbal diagnostic tests, even with Alzheimer’s. Sadly, not only does this mean they don’t receive much needed support in these early stages, by the time they do receive a diagnosis the condition has progressed and rapid deterioration has set in. 

The late diagnosis of autism in females is due to diagnostic criteria based on male presentations, such as antisocial behavior and hyperactivity. Socioculturally speaking, young girls are typically encouraged to internalise their emotions, rather than express issues or frustrations externally because it’s considered rude or unattractive to do so. They are taught that social acceptance and approval are imperative, and so what we see as a result of these social pressures, is an increase in coping strategies like ‘masking’, by which a person suppresses certain behaviours and/or mimics others’ in order to appear neurotypical and fit in socially. 

As disheartening as a lot of this is, if proper investment is put into research and education, life changing reforms and advancements can be made to the world of women’s health. Until then it’s more important than ever that we get equipped with the information and tools to advocate for ourselves in these medical settings. 

What this can look like is:

• Prior to doctors appointments, keep a log of any symptoms you may be experiencing and write out the questions that you want answered by your practitioner. 

• Ask trusted people for their recommendations for safe and supportive practitioners and be proactive in sharing your own recommendations. 

• Most importantly, be prepared to move on to another practitioner if you feel like you’re not being listened to. 

Steps like these will give you the best chance of finding practitioners that understand and care about your experience in order to receive comprehensive and informed medical care and treatment. As you deserve.

Written by Nina David.

Nina is a student Sexologist with a background in theatre and performance. She has hands-on experience supporting people with disabilities, specialising in high needs clients. Nina brings adaptability and a deep respect for individual autonomy to her work. She aims to connect, communicate, and put people at ease. Nina advocates for body acceptance and actively challenges societal stereotypes around gender, sexuality, and pleasure.