“There’s a pain gap, but there’s also a credibility gap. Women are not believed about their bodies — period.”

— Anushay Hossain, author of "The Pain Gap," Washington, D.C.

Can I ask you a personal question?

Is pain sexist?

It may not surprise you to hear that gender biases start impacting how a doctor perceives pain in patients as young as five years old. A recent study found that when a doctor heard a five-year-old patient cry out, they rated their pain as 50.42 (out of 100) when they were told it was a boy and 45.9 when they were told it was a girl. This is consistent with recent findings published in the Journal of Pain regarding how caregivers perceive pain in adult women vs. men. We don’t have to tell you that medical gaslighting has been impacting women for, well, ever. Women are less likely to be prescribed painkillers, experience longer emergency department wait times, and are less likely to get properly diagnosed with heart disease. But why? 

Why is our pain underestimated?

When we hear statistics like the ones above, the first place most of our heads go to is gender biases. In addition to the studies assessing doctors’ and caregivers’ perceptions of pain referenced in the previous paragraphs, research shows that when it comes to how they handle their chronic pain, men are generally considered “stoic” by their healthcare teams. In contrast, women are considered “emotional” and “hysterical” (the language we use to describe men vs. women deserves – and will have – its own separate post). So gender biases certainly play a role. 

But bias isn’t the only explanation. Women’s pain is also vastly under-researched. While women make up 72% of chronic pain sufferers, 80% of studies on chronic pain are conducted on men or mice. In fact, women weren’t even required to be included in clinical trials until 1993, and even today pregnant women remain excluded and diverse representation is weak. (This is problematic, to say the least, considering minority women are overrepresented across many major diseases such as heart disease and diabetes). So sometimes, women’s pain is dismissed simply because there’s not enough research to connect it to a proper diagnosis. For example, women tend to experience heart attacks differently. When women present with heart attack symptoms unique to our gender, like nausea and back or jaw pain, we can be dismissed and risk not getting the diagnosis we need to be treated. 

Research also shows that women actually do experience pain more intensely than men (i.e., we’re not being overly sensitive). And treatment varies as well. For one, our opioid receptors respond differently to opioid medications than men, making pain relief slower (this is complicated because the solution isn’t necessarily to up our opioid intake, considering the risk of addiction associated with these drugs). While research is limited, there are also preliminary findings that sex hormones play a role in how men and women experience pain differently, with testosterone being at least partly responsible for men’s increased pain threshold and estrogen having the opposite effect. This all suggests that we are simply biologically built to sustain less pain. Not great.

What are the consequences? 

So why does all of this matter? Well, the problem with women’s pain being underestimated is that it can translate to women being undertreated which can then lead to extended discomfort and worse prognoses, including death. 

Remember the study mentioned in the intro about how caregivers tend to underestimate female patients’ pain? The same study reported that as a result, women patients are more likely to be prescribed psychotherapy, while their male counterparts are more likely to be prescribed pain medication. In other words, we’re being told to suck it up and mentally rewire our brains to feel less pain (or worse, that we’re crazy). Further, new research from 2023 finds that women are twice as likely to die after a heart attack than men, with atypical symptoms being a potential partial explanation. 

For conditions that are unique to women, like endometriosis (impacting 1 in 10 women), not taking women’s pain seriously has led to it taking an average of 10 years to get a diagnosis. On top of experiencing heavy bleeding and debilitating cramps due to the cells growing and attaching to their ovaries, fallopian tubes, and/or pelvic organs, women with endometriosis are also building up scar tissue each month - making it harder and harder to get pregnant later on. Here, the consequences of ignoring period pain aren’t just lowering a woman’s quality of life - but also potentially preventing her from proactively addressing infertility.

Is there any hope?

The good news is that there is light at the end of this dark tunnel. While only 11% of NIH funding goes toward women’s health, women’s health (and pain) is getting more attention. Late last year, Jill Biden announced the first-ever White House initiative dedicated to women’s health research and last month pledged $100M to fund it. It’s also infiltrating pop culture. Earlier this year, the period pain relief company Somedays released a period cramp simulator. One TikTok video that went viral showed a police officer wincing and describing the pain as a 6 out of 10, saying he wouldn’t want to go to work while experiencing such pain. Finally, period cramps get some respect. 

There have also been several recent medical breakthroughs that demonstrate what can happen when people start taking women’s pain seriously. For example, morning sickness has been considered a rite of passage for pregnancy forever (note: morning sickness isn’t just limited to the morning. For many women, it’s all day long and sometimes for all 9+ months). But late last year, the cause of morning sickness was finally discovered - a hormone known as GDF15 that is produced at higher levels during pregnancy. With the cause pinpointed, there’s now hope for a cure. On a related note, in 2018, the FDA approved a novel preventative migraine treatment, changing the lives of chronic migraine sufferers (85% of whom are women). As of 2020, over 440K people across 44 countries have been prescribed the medication that was shown to reduce days of migraine by as much as 50% (which is incredible for chronic migraine sufferers experiencing 15+ days of migraine per month). 

What does this mean for you?

Knowing that women’s pain is more often dismissed and understanding why can help you challenge expert opinions that don’t feel right and advocate for yourself and your healthcare needs. While the gender health gap in general is frustrating, sometimes the pain gap can be considered even more exasperating because pain is subjective and thus requires perceivers (i.e., doctors) to believe us. And as women, we know how hard it is to get the world to listen to and believe us. But as always, knowledge is power. So the more we know what to expect, the better we can plan for what’s coming. 

Let us know what you think by voting in our poll and leaving an anonymous comment.

  💭 Our two cents

What first caused me to become intrigued about the topic of women and pain was the countless stories of friends going through what they’ve categorized as “the worst pain of their lives” to get an IUD inserted. Later, when I listened to Serial’s latest podcast series, The Retrievals, I became even more interested / incensed: this is the story of the Yale fertility clinic where women were getting their eggs retrieved unmedicated because a nurse replaced the anesthesia with saline. With The Retrievals, I was frustrated that no doctor or nurse questioned why all of a sudden women were screaming out in pain. Rather than reviewing their own practices, they assumed dozens of women were just being overly sensitive. My research for today’s issue shows the same conclusion exists across medical conditions. And it got me thinking - why is the male experience considered the default experience? Not just when it comes to pain, but across our lives. I suppose it’s a good reminder to not simply accept unfavorable circumstances as the status quo but to question and challenge them. Here’s to hoping for more attention to women’s pain, and more solutions to alleviate it.

 ✅ You should also know…

💉The Retrievals: For fans of Serial, you won’t want to skip this 5-part series that follows the scandal at a Yale Fertility Clinic that led to dozens of women going through the painful egg retrieval process unmedicated. 

🤒Unwell Women: Want to dive deeper into the gender health gap? Check out this book that explores “misdiagnosis and myth in a man-made world.”

♀ Invisible Women: Interested in other areas of life where the lack of research on women has led to less-than-ideal circumstances for us? This book dives into the gender data gap across many spheres of life. It’s an absolute must-read!

💃 The girls have spoken

Last week, we asked you about the largest age gap you’ve ever experienced in a relationship. And your answers revealed what you might not be too shocked to hear: age gaps are a lot more common than common discourse might suggest.

• Over 20% of you have been 5 or more years younger than your partner in a past relationship

• Nearly half of you have been 1 - 5 years younger than your partner (note: as women tend to be, on average, the younger partner by a year or two, this is consistent with national data)

• Only 20% of you have always stayed within a year of your partner’s age

• About 15% of you have actually experienced the largest age gap when you were the older partner by 1 - 5 years

And, as always, your comments were just as insightful as the data. One reader noted that, when it comes to thinking about age gaps in relationships, it can be especially helpful to evaluate the life milestones that you and your partner are planning to reach in the near future. These major milestones, on average, tend to be skewed more towards the first half of our life – finishing school, establishing our careers, getting married, buying a home, having children – and our growth during this time is often dramatically fast, all of which can make age gaps earlier in life feel even larger than they are. Through this lens, it’s not hard to see why the half-your-age-plus-seven calculation has become such a helpful reference point for many.

Another reader shared that they always sought older partners, either consciously or subconsciously equating age with maturity. But it wasn’t until they met their now fiance, that the trend was broken for them. We love this story because it so clearly illustrates how not adhering too closely to rules, whomever’s rules they may be – yours, your friends’, your family’s, society’s – could open you up to paths in your life that would otherwise be closed off but would truly make you happy. Not every detail of our relationships has to satisfy a precise, predefined, complex, and magical formula. Some details can just be details. :)

💌 Up Next

That’s all for today! If you liked this edition of Not That Personal, we think one of your friends probably will too – refer one (or two or three) below. ;)

Have something to say? We’d love to hear it – reply to this email or leave an anonymous comment here :) 

Up next: So…should I be worried about deepfakes?

💖 S & J