The Chronic Dismissal of Female Suffering

Authored by: Sophie Elijovich

Art by: Jane Wang

“I was told that I was experiencing psychosomatic pain stemming from guilt for sinning with boys,” [1]. Those were the words of Melanie, a woman who spent ten years in excruciating pain before finally being diagnosed with endometriosis that her new surgeon “said was one of the worst cases of endometriosis in a young person she had ever seen” [1]. Another victim, Truzane, who was eventually diagnosed with microvascular heart disease, said “I was told that I was a female who was looking for attention, and that they see no sign of anything else wrong with me, except for maybe it was in my head” [1]. Unfortunately, Melanie’s and Truzane’s tragic accounts of the dismissal of their symptoms and the insulting, flawed rationalization of their pain by doctors are not isolated incidents—rather, they are just two instances of a pervasive issue. Systemic misogyny has led to great gender disparities in healthcare, including in the diagnosis of illnesses, in medical treatment received, and in decisions regarding pain management, leading to devastating consequences for women.

As evident in the cases of Melanie and Truzane, a culture of disbelief that spurns the suffering and symptoms of women creates a patronizing environment with great obstacles for female patients searching for diagnoses. According to a survey by the Kaiser Family Foundation, women are more likely than men to report that, “a health-care provider had assumed something without asking, talked down to them, didn’t believe them, or refused to order a test or treatment they thought that they needed” [2]. Additionally, qualitative studies and survey evidence show women are more likely than men to have their symptoms dismissed [2]. This dismissal of female suffering stems in part from the misogynistic stereotype of women as being overly emotional. Due to this bias, women are told more often than men that their symptoms are caused by emotional factors rather than physical ones [2]. In an analysis of disease progression patterns, Westergaard et al. found that “in the majority of cases, women were, on average, diagnosed at an older age than men” [3]. This difference may result from the dismissal and disbelief of female symptoms in comparison to male ones, which make it more difficult for women to receive accurate diagnoses. Even when implicit, the sexist characterization of women as more emotional than rational casts doubt on the validity of their experiences and dismisses their suffering as imagined, impeding efficient and accurate diagnosis. 

This belittling and dismissal of women’s symptoms affect not only diagnosis, but also treatment. In comparison to male patients, female patients are less likely to receive aggressive treatment for a variety of heart issues and less commonly receive preventative treatment for blood clots when they are hospitalized [2]. Among patients with irritable bowel syndrome, men receive more imaging than women, who are more likely to receive tranquilizers and lifestyle advice instead [2]. This pattern continues in the area of pain management. For example, in the treatment of emergency department patients with acute abdominal pain, even though women and men had similar average pain scores, women were less likely to be given any analgesia (medication for pain relief that does not cause loss of consciousness), even when excluding gender-specific diagnoses [4]. Women were also 13% to 25% less likely to receive opioid analgesia than men were, even after controlling for race, triage class, and pain score. Additionally, women had a longer median wait time for receiving pain medication [4]. This trend is not limited to abdominal pain. In fact, when patients of both genders have the same complaints, female patients are less likely to be prescribed pain-relief medication than male patients [5]. According to Guzikevits et al., psychological research suggests a “ ‘gender–pain exaggeration bias’: Women are believed to report their pain in an exaggerated manner compared to men” [5], reflecting the misogynistic tendency to dismiss women’s symptoms as imagined or caused by emotional factors. Evidently, the stereotype of women as being overly emotional not only invalidates their experiences, but also impairs their chances of adequate treatment, prolonging their suffering.

The flagrant gender discrepancies in medicine are detrimental to women’s health. As Borrell et al. explain, these “Gendered inequalities in health reflect the fact that women suffer more than men from a host of nonfatal, disabling physical and mental illnesses and are generally expected to live fewer years in good health despite having a higher life expectancy” [6]. In fact, women report lower health-related quality of life than men, a finding that agrees with morbidity measures and is not due to greater tendency to report [6]. Biology plays only a small role in these health differences between sexes; the greater suffering of women is mostly related to gender inequalities [6]. The gender inequity in acknowledgement of symptoms also has an economic impact, since eligibility for social insurance programs depends on medical evaluations, and there are large gender gaps in such programs [7]. Ultimately, the chronic dismissal of female suffering and the resulting gender disparities pervasive in medicine have devastating effects on women, their health, and their lives. It is far past the time for healthcare systems to eliminate these toxic and dangerous inequalities. And the first step, of course, is to believe women, their symptoms, and their pain.

References:

1. Borrell, C., Palencia, L., Muntaner, C., Urquia, M., Malmusi, D., & O’Campo, P. (2013). Influence of Macrosocial Policies on Women’s Health and Gender Inequalities in Health. Epidemiologic Reviews, 36(1), 31–48. https://doi.org/10.1093/epirev/mxt002

2. Cabral, M., & Dillender, M. (2021). Disparities in Health Care and Medical Evaluations by Gender: A Review of Evidence and Mechanisms. AEA Papers and Proceedings, 111, 159–163. https://doi.org/10.1257/pandp.20211016

3. Cabral, M., & Dillender, M. (2024). Gender Differences in Medical Evaluations: Evidence from Randomly Assigned Doctors. American Economic Review, 114(2), 462–499. https://doi.org/10.1257/aer.20220349

4. Cedars Sinai. (2020, March 6). Gender Disparities in Healthcare | Cedars-Sinai. Youtube. https://youtu.be/FwJrXlpuaJU?si=HVnyGeItBQKduVRt

5. Chen, E. H., Shofer, F. S., Dean, A. J., Hollander, J. E., Baxt, W. G., Robey, J. L., Sease, K. L., & Mills, A. M. (2008). Gender disparity in analgesic treatment of emergency department patients with acute abdominal pain. Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine, 15(5), 414–418. https://doi.org/10.1111/j.1553-2712.2008.00100.x

6. Guzikevits, M., Gordon-Hecker, T., Rekhtman, D., Salameh, S., Israel, S., Shayo, M., Gozal, D., Perry, A., Gileles-Hillel, A., & Shoham Choshen-Hillel. (2024). Sex Bias in Pain Management Decisions. Proceedings of the National Academy of Sciences, 121(33). https://doi.org/10.1073/pnas.2401331121

7. Westergaard, D., Moseley, P., Sørup, F. K. H., Baldi, P., & Brunak, S. (2019). Population-wide analysis of differences in disease progression patterns in men and women. Nature Communications, 10(1), 1–14. https://doi.org/10.1038/s41467-019-08475-9