‘It will just be a mild discomfort, dear’: Unpacking the gender pain gap

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By now most of us will be aware of the pay gap, and hopefully benefitting from the measures slowly coming into place (?!) Although the pandemic has dictated that employers do not have to declare their statistics in 2019/20. Let’s keep watch on that. But I digress. What I’m here to talk about is the gender pain gap. I recently joined a webinar hosted by Hysterical Women and The Femedic entitled ‘How close are we to closing the gender pain gap?’ The panellists were a fantastic collection of clinicians and researchers specialising in women’s health – Dr Omon Imohi, Dr Hannah Short and Dr Katy Vincent. And all the attendees were passionate and educated, all sharing their perspective on the topic. Honestly, there was gold in that Zoom chatbox. 

But before I dive into what I learned about the realities of the pain gap, let’s explore its origins. Essentially it stems from time-old misconceptions from male physicians who believed that women’s pain was mostly mental. Those looking for support from their doctor were deemed hysterical. They even institutionalised women because of it. Lobotomies were commonplace to help solve the woes of women. But why didn’t medical research show otherwise? Because medical trials did not cover female biology. It was only in 1993 that it became a a requirement to include women in them. Yep, that’s 1993 not 1893. So, even in modern medicine, healthcare is based on biased data. The good news from the webinar panel is that in the last five-ten years, there has been a significant uptake in research around gender differences. The ripple effect will begin to show. 

But what struck me about the subject was that before joining the discussion I’d been unable to humanise the gender pain gap. I’d struggled to draw on my own experience. It’s not that I didn’t believe it existed; I couldn’t bring it to life. I’ve been lucky enough never to have major surgery, nor do I have a chronic condition. So, it doesn’t affect me? Wrong.  

I’m going to start with breastfeeding. Now, I know that breastfeeding experts will say that it should not be painful. But, when I began breastfeeding my son, it hurt. I sought out lots of expert advice, and was reassured that his latch was right and he didn’t have tongue-tie. So, why was it so uncomfortable? Step in my sister. She said it is slightly painful to begin with, and it will be until your nipples get used to it. Smear on the nipple cream, and you’ll be ok soon enough. When I asked health visitors how I’d know if the discomfort was too much, they said it shouldn’t be more than five seconds of toe-curling pain. That was the barometer for the pain. And don’t get me started on the agony of mastitis or blistered nipples. But there it is, the first example of a pain we must stomach and not talk about as women. 

Next up, is the joy of the UTI. Several of the webinar participants mentioned problems around chronic UTIs. Now, I’ve not had chronic bladder infections, but I’ve certainly had my share of excruciating bouts. One led me to call 111 over the Christmas break. The advice was to take a paracetamol and try to sleep. My agony and constant pacing certified that was not going to fix it. I pushed and got the emergency appointment for antibiotics that I desperately needed. Cystitis pain is indescribable. It’s all-consuming and nothing sooths it. My heart breaks for those suffering chronically and can only hope progress comes quickly in the research. 

And, how could I forget the coil or IUD? Here, again, I was the lucky one. When I had my copper coil fitted, I had a local anaesthetic, and as a result, the procedure was uncomfortable but bearable. I know several friends, however, who fainted because of the pain. Their doctors didn’t prepare them for the pain or offer them the anaesthetic. It’s a complete postcode lottery if the provider you go to does this. So, women routinely pass out in the process. If you think about it, the nerve endings in our cervix and uterus will all be unique. It stands to reason that some women will feel more sensitivity there. I mean, we know for a fact that only some women can orgasm through penetration. Every vagina is different, but the standard of care should be the same. 

Building on this, last night, I had an education about the hysteroscopy procedure. It is endoscopy of the womb – the method used to detect cancer, pre-cancer and benign abnormalities. For 75% of patients, the procedure is uncomfortable or bearable, but for the other 25%, it is torture and often traumatising. Campaign groups are asking that all patients are offered multiple pain relief options as standard. But speed and cost appear to stop the hospital trusts from doing that. Currently, it is an outpatient procedure and adding additional levels of pain relief would change that. The advice given to most women is that it’ll be a mild discomfort and a pain killer will solve it. The testimonials say otherwise. In summary, hospitals are choosing budgets over the pain of their patients. 

And I want to finish on childbirth. Here I need to admit my own bias. I used hypnobirthing in my first labour and am currently training to teach it. I believe it is not birth that is painful rather its medicalisation. A complex set of muscles, mindset and hormones mean the body is naturally able to birth a baby. However, disruptions, such as invasive vaginal examinations and interventions or early inductions, remove the ability for this to happen. I want to caveat that giving birth was the most intense experience of my life, but I knew what was happening to my body. Those who labour without knowing what’s happening, or without control, will be in pain. So here the emphasis should be on education and support from the maternity community. Due dates should be a window, not a certainty. There’s so much to unpack where it comes to maternal care, but I’d be remiss to exclude it when talking female pain. 

So, there we have it, a small but awful snapshot of the pain experienced as a standard. The brilliant news from the panel of clinicians and researchers was that the next generation ask more questions and have done their research. They’re not as willing to accept everything as gospel. Change is coming and bloody hell we need it.  

In the meantime, here’s some advice on how we can all influence the gender pain gap: 
  • Speak up – if you had a medical procedure which caused you a great deal of pain and badly affected you, please do seek support. And if your mental health permits it, submit an official complaint to the hospital trust. 
  • Keep an open mind – clinicians, of course, are highly trained and highly skilled. But that doesn’t mean we can’t question the options presented to us. If it doesn’t feel right, look around for more research or for communities that have more answers. 
  • Track what feels ‘normal’ – technology is a brilliant way to help us better understand our bodies. Is your cycle causing you discomfort, either mentally or physically? Clue is a great way to keep an eye on the trends each month. If you have endometriosis, Syrona Health now has a symptom tracker. 

If you’re a women’s health start-up or campaign group looking to spread the word about the gender pain gap, please do get in touch. I’d be happy to help you educate the world.