There's A "Pain Gap" - And It's Hurting Women

Em Unravelling

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Two weeks ago, a good friend of mine popped into her doctor’s surgery during her lunch hour to have an IUD fitted. An IUD — “intrauterine device” — is also called a coil, and it’s a tiny T-shaped piece of metal or plastic that needs to be inserted into the womb through the neck of the cervix and then left there. It prevents pregnancy, and some types of IUDs also release hormones to regulate a woman’s menstrual cycle or to smooth the passage of early menopause.

So far, so good. And my friend has given birth vaginally to children and she’s had plenty of smear tests in her lifetime, so she went to the doctor without a second thought. Off she went to the doctor’s surgery, up she hopped onto the paper-covered vinyl bed that all women are so grimly familiar with from pelvic exams, and obediently she slipped her feet onto the waiting stirrups so that the doctor could “pop the IUD into place”.

Only — there was no popping of anything into place. What followed for my friend was a muted half-hour of suppressed agony as she tried stoically to be “brave” while the doctor, for her own part, tried again and again to open the recalcitrant cervix.

After half an hour and a lot of held-back tears, my friend called time on the whole thing, and the doctor finally gave up. “Sorry,” she said. “This does happen quite a lot. You’ll need to make another appointment on another day and we’ll see what we can do about a sedative.”

We’ll see what we can do about a sedative.

My friend went home and she had to go to bed. For the next couple of days, she experienced cramps and bleeding that reminded her of labor.

It’s more than “uncomfortable”

My friend’s experience is not even slightly rare (if it hasn’t happened to you, then try asking a few friends — I’m willing to bet at least one of them has had a similar experience), but it was very timely.

Recently, Lucy Cohen launched a survey online after her own horrifically painful experience of IUD insertion, and the results of that survey spoke loudly about the way women are treated for “straightforward” gynecological and contraceptive procedures such as this one.

Cohen received answers to her survey from around 1500 women, almost all of whom described horrific and debilitating pain during a procedure that is commonly described (and has been described to me personally, by NHS staff in the UK) as “possibly a bit uncomfortable for a minute or two”.

Cohen’s results were depressing, if not surprising. She found out that 93% of the women who responded had experienced pain during IUD fitting. (Not discomfort; pain). 25% said it was “almost unbearable” or “excruciating”. 71% of the women responding said that they had not been told what to expect; more than 52% of the women had been offered no pain relief at all.

There’s a gender gap not just for pay, but for pain

The results of Cohen’s survey are self-evident. Women are not adequately informed about the procedures they’re invited almost casually to go through, and this means they are routinely surprised by the pain they experience. (The shock of it, or the fear that it’s unusual to have so much pain for something other women don’t seem to notice, may even make it worse). They’re not being supported adequately in advance of the pain, or while it is happening, or afterward. All of this is true.

But all of this speaks, too, to a more widespread and entrenched problem in the medical profession. And that problem is simply this: that there is a gender pain gap. It’s there, and it punishes women.

A study published this year by the US Association for the Study of Pain had the following conclusion:

Women’s pain [is] viewed as less intense and as benefiting more from psychotherapy than men’s pain, and perceivers’ gender role stereotypes about willingness to report pain explained some of this bias in pain estimation. These findings suggest that gender biases in pain estimation may be an obstacle to effective pain care, and that experimental approaches to characterizing biases…could inform the development of interventions to reduce such biases. — USASP

So not only is women’s pain under-estimated — our reports of its severity or impact are routinely disbelieved, based on pre-existing biases about how “weak” we might be — but also, it is under-treated. Even when we are believed in our pain, we’re not offered enough medicine to make it go away. We might not even be offered medicine at all.

Things are very different when men are involved

Men, obviously, do not have IUDs fitted. Men don’t have smear tests. Men don’t have cervixes. It’s impossible to make a like-for-like comparison here on pain levels for the same medical procedure on men and women.

What men do have, though, is colonoscopies. Colonoscopies are procedures that are offered to both men and women, because both sexes have colons, and if either a man or a woman is experiencing a medical issue that requires the colon to be examined then that is done via a camera, carefully inserted into the body through the anus.

Obviously, there are some clear differences from the outset. For one thing, men are not offered colonoscopies as a routine procedure (in the way that women are offered IUD insertion routinely as contraception, as casually as being offered the pill, or even condoms). It’s all much more medicalized because it’s a procedure that is triggered by an existing problem.

But another clear difference? A huge, important difference? Well, that difference is that a colonoscopy is always accompanied by pain relief. There is no way that any patient would be expected to lie down and have a colonoscopy without gas and air, or some other form of analgesia, right on hand to provide sedation and pain relief. It just wouldn’t happen. Of course, it wouldn’t! The procedure would be too painful! For heaven’s sake, it involves something solid and hard being pushed into a soft part of you!

Which is, coincidentally, exactly what an IUD insertion involves.

What can we women do, apart from getting angry?

As with so many aspects of life as a woman, to be forewarned is to be forearmed. When we are aware of the likelihood that our pain will be minimized or glossed over by medical professionals, we can try calmly to pre-empt that happening.

Rather than automatically believe a breezy “It might be a bit uncomfortable!” on a medical website and then feel abnormal or fearful if that turns out not to be the case and we find the procedure agonizingly painful, we can remind ourselves that gynecological procedures, while commonplace, can involve intrusion into very sensitive and delicate areas of our bodies and it is not wrong for that to hurt. In fact, it’s quite likely that it might hurt.

And if it does hurt, we’re not weak or wrong for wanting support with that pain and we should remind ourselves, and our friends, of this fact. As women, we have a right to not suffer agonizing pain in the pursuit of a simple medical procedure that has — after all — ultimately been designed to improve our lives. Not only do we have a right not to suffer it, but medicine actually exists so that we don’t have to suffer it.

We should feel as entitled to pain relief for an IUD insertion as we do to having fully numbed gums if we go for root-canal surgery. Pain relief for women-only procedures needs to be as normalized as pain relief for procedures that both men and women undergo regularly.

That, I think, is the best way to begin to close the gap. And then, we can start to work on why even for the types of pain that both men and women suffer, women are so much less likely to be believed about its severity.

That’s a longer, older story, but it’s still one that needs to be dismantled.

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A lover of horizons, hills, and words. Likes to write about uncomfortable things because too many people steer round those parts of life.

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