Why Do Doctors Take Women's Pain Less Seriously?

Woman in pain often wait longer to receive pain medication than men do. Pamela Moore/iStock

At only 25, Ally Niemiec of Atlanta has been diagnosed with two kidney diseases and endometriosis. She has had a remarkable 28 surgeries in the last five years and deals with chronic pain that leaves her unable to work, drive and keep many relationships.

Despite her rock-solid diagnoses and obvious distress, she has been ignored in emergency rooms and refused pain medication when she was in agony. Niemiec said she has often been made to feel as if she were a drug addict or that she was exaggerating her pain.

Interestingly, she is in several support groups with men who have the exact same symptoms and have made similar trips to the ER — yet they are treated much differently.

"The men don't have any experiences like us women," Niemiec says. "We are sent home. The men in our support group are constantly in the hospital having their pain addressed."

Delay in diagnosis

According to a 2015 study, women waited longer than men to be diagnosed with several different types of cancers. It's not because the women delayed going to the doctor once they noticed symptoms. The delays in diagnosis occurred after a woman's initial visit to a primary care physician.

In the U.K., twice as many women compared to men had at least three primary care visits before the doctor would refer them to a specialist, reports BBC, which took an extensive look at women's healthcare in the U.K.

"We want to think that physicians just view us as a patient, and they’ll treat everyone the same, but they don’t," Linda Blount, president of the Black Women’s Health Imperative, told BBC. "Their bias absolutely makes its way into the exam room."

What other studies show

Researchers have shown there's often a gender disparity in the U.S. in how men and women are treated when it comes to pain.

In a 2008 study of nearly 1,000 people who visited an emergency room, men and women reported similar pain scores, yet women were 13 to 25 percent less likely than men to receive opioid pain medicine. In addition, women waited longer to receive their pain medication — 65 minutes versus 49 minutes on average for men. The study was published in the journal Academic Emergency Medicine.

Another study from 1990, published in the journal Sex Role, looked at the medication records of 30 male and 30 female patients who had recently undergone coronary artery bypass graft surgery. The results showed that the male patients were given pain medication more frequently than the female patients, while the women were more likely to be given sedatives, rather than actual pain medicine, for their pain.

The authors wrote that, "the hypotheses in the study were based on a review of the literature indicating that health care professionals hold stereotypic views of women as emotionally labile and more apt to exaggerate complaints of pain than men."

In a study of more than 1,300 outpatients being treated for cancer, researchers found that of those who weren't getting adequate treatment for their pain, women were significantly more likely than men to be undertreated. The study was published in the New England Journal of Medicine.

A firsthand experience

In 2015, writer Joe Fassler ran up against this gender bias when his wife, Rachel, was rushed via ambulance to the ER after she awoke in anguish one morning with abdominal pain. He told her story in The Atlantic, noting that the hospital staff downplayed his wife's pain, even ignoring it.

He flagged down the first nurse he could.

“She’ll have to wait her turn,” she said. Other nurses’ reactions ranged from dismissive to condescending. “You’re just feeling a little pain, honey,” one of them told Rachel, all but patting her head.

It turns out Fassler's wife was suffering from ovarian torsion — a surgical emergency — yet, she waited more than 90 minutes for pain medication and wasn't even examined by the first attending physician. She finally was diagnosed and sent to surgery an unbelievable 14.5 hours after her pain had started.

Pain is subjective

faces pain rating scale
Even though women often rate their pain more highly than men on a rating scale such as this one, they are often undertreated for it. Sunshine_Art/Shutterstock

More than a decade ago, two University of Maryland professors delved deeply into the topic of men, women and pain. Their research, put forth in a paper titled, "The Girl Who Cried Pain: A Bias Against Women in the Treatment of Pain," looked at both whether the sexes experience pain differently and what accounts for the difference in pain treatment they receive.

Studies showed that women have lower pain thresholds and higher pain ratings than men, yet they typically are more likely to receive less treatment for their pain.

"The bottom line is the real mismatch," paper co-author Diane Hoffmann, professor of law at the University of Maryland Carey School of Law, tells MNN. "You would expect women to be treated better and more aggressively."

In their research, Hoffman and her co-author Anita Tarzian, associate professor in the University of Maryland School of Nursing, found all sorts of reasons that health care providers may be biased in the way they treat men versus women for pain.

  • Men typically complain less than men, so when they do complain, "it must be real."
  • Women should be able to tolerate pain better, after all, they can handle childbirth.
  • Women aren't accurate when reporting pain; they tend to complain and exaggerate.

The researchers reference something known as the "Yentl Syndrome," where "women are more likely to be treated less aggressively in their initial encounters with the health-care system until they prove they are as 'sick as male patients.'"

Ironically, gender isn't the only bias. Physical attractiveness has been found to play a part in how health care providers respond to a patient's pain. In a study published in the journal Psychology & Health, researchers found that physically unattractive patients were perceived to be experiencing greater pain than attractive patients. Pretty and handsome people were thought to be better able to handle their discomfort.

Such broad biases are impossible fight. Niemiec finds it difficult to even describe the fear and frustration she experienced when doctors and nurses discount her pain.

"It’s not even something you can begin to explain," she says. "There is nothing more terrifying. It is the worst feeling in the entire world. These people (health care workers) are supposed to be helping us."