Women and pain: When gender bias affects pain management
Key Takeaways
Evidence suggests that gender bias may cause some clinicians to underestimate the pain that women experience.
Physicians are less likely to prescribe women pain medications, including analgesia and opiates, when compared with men, according to past research. Further studies show that those who perceive pain are more likely to prescribe painkillers for men, and psychotherapy for women.
Experts recommend focusing on treating pain based on the pathology—not the patient’s gender—and they advise checking with the patient periodically during a potentially painful procedure to assess their need for more pain management.
“No one prepared me for how painful it was going to be.”
That was the comment of a TikTok user on a video of a mock IUD insertion. This TikTok, duetted by interventional pain specialist Kunal Sood, MD, has over 100,000 comments, many written by users who also experienced intense pain during an IUD insertion.[]
Research shows that women’s pain is commonly underestimated by clinicians. To get a better understanding of the gender-pain gap, MDLinx reached out to Dr. Sood, who encourages clinicians to address this disparity by committing to making their patients comfortable.
Gender bias in pain perception and treatment
Researchers have known for decades about the very real consequences that gender bias can have in the exam room, especially when it comes to pain.
One study published by Academic Emergency Medicine, for example, found that women with acute abdominal pain were 13%-25% less likely to receive opioid analgesia when compared with men with the same condition.[]
Current research sheds light on other ways in which gender bias may affect pain perception and management.
A 2021 study published by the Journal of Pain looked at the role of gender bias in the perception and estimation of pain, and in the types of pain treatments offered for men vs women.[] The researchers controlled for facial expressiveness and self-reported pain.
Both before and after the controls, the perceivers (consisting of lay people who may lack formal medical training) estimated that female participants experienced lower levels of pain than their male counterparts.
Perceivers also consistently overestimated men’s pain while underestimating women’s pain.
Moreover, when the perceivers were asked to recommend either psychotherapy or pain medicine to treat each patient, they preferentially chose pain medication for both men and women, but at different rates: 62% for men vs 58% for women. Psychotherapy was chosen for only 38% of men vs 42% of women.
The perceivers therefore not only overestimated men’s pain, but they also were more willing to prescribe medication over psychotherapy for men than for women.
These findings suggest that those who perceive pain—including clinicians—may be influenced by pain-related stereotypes rooted in gender that could alter pain estimation and treatment recommendations.
It’s also worth noting that most pain research focuses on men’s experiences, thus creating “norms” that lack the perspectives of women, according to a review published by Pain Research and Management.[]
Applying this research to women may therefore perpetuate gender disparities in pain perception and management.
Clinical findings represent only the tip of the iceberg. Anecdotal evidence from women abounds—some of which you can find in the palm of your hand.
When it comes to women’s accounts of unaddressed pain, there’s no shortage of disturbing stories.[]
“I had a gynecologist imply that if my pain wasn’t driving me to suicide, then it mustn’t be that bad. On the other hand, I’ve had the domino effect of overprescription of antibiotics causing new problems whilst not solving the old ones," said Avery Mandeville, front woman of the band Little Hag, who responded to MDLinx in an exclusive interview.
Mandeville is open about her negative experiences trying to get help for undiagnosed pelvic pain, as expressed in a Little Hag song performed on TikTok.
Like Mandeville, women on TikTok have been vocal about the lack of pain management they’ve encountered in medical interactions—and the changes they want to see made as a result.
How to address the pain gap
Clinical studies and anecdotal accounts suggest that women’s pain is too often dismissed or downplayed. As a clinician, you may be wondering, “How can I address this?”
According to Dr. Sood, the answer may be as simple as keeping your focus on the illness, not the patient’s gender.
"I don’t try to put patients in boxes. Each patient should be treated uniquely for their pathology."
— Kunal Sood, MD, personal interview
Since every patient experiences pain differently, Dr. Sood believes in adjusting treatment and pain management methods to the individual.
“I would recommend to just listen to the patient,” he said.
“Say you’re doing a procedure, and the patient starts feeling a lot of pain,” Dr. Sood said. “You can always stop the procedure and say, ‘Hey, do you want to try this later?’ or offer, ‘We can give you a little more anesthesia’ or ‘I can give you more topical spray.’”
In the IUD insertion TikTok, Dr. Sood comments that a paracervical block, as well as local and general anesthesia, are proven to reduce pain during that particular procedure. Based on the comments, that may be a useful method for clinicians to employ in the future.
What this means for you
Evidence suggests that clinicians may underestimate women’s pain or leave it unaddressed. This may be a result of gendered norms, which perpetuate the unfounded idea that there are concrete differences between the ways in which men and women experience pain. Clinicians can disrupt this dynamic by being aware of gender bias in pain perception, carefully listening to the patient, always treating pain based on the pathology—not the patient’s gender—and checking with the patient periodically during a potentially painful procedure to assess their need for more pain management.