The Pain Gap: Why Women’s Pain Is Undertreated

Women’s pain is often dismissed or not believed

It's widely known that although women experience more chronic pain conditions than men — whether it's fibromyalgia, endometriosis, or migraine — their pain is treated less seriously. In a 2019 HealthyWomen survey, 45% of respondents said they didn't think their healthcare providers took their pain seriously. And there are facts behind those feelings: Women experiencing pain are more likely than men to receive a sedative prescription instead of a pain medication prescription.

The gender pain gap extends to the emergency room, where men wait an average of 49 minutes before receiving pain medication in instances of acute abdominal pain while women wait an average of 65 minutes in the same situation. Women are even half as likely as men to receive painkillers after a coronary bypass surgery.

In the paper, "The Girl Who Cried Pain: A Bias Against Women in the Treatment of Pain," Diane Hoffman and Anita Tarzian found that "women report more severe levels of pain, more frequent incidences of pain, and pain of longer duration than men, but are nonetheless treated for pain less aggressively." But what is it about women in pain that is so easily shrugged off by healthcare providers?

Dr. Sharon Allison-Ottey, an internal medicine physician and a member of HealthyWomen's Women's Health Advisory Council (WHAC), says women are often considered histrionic when they complain of pain. "They're not taken as seriously, whether that's chest pain and they're having a myocardial infarction or they've just broken a bone," Allison-Ottey said.

"There is the perception of the big, strong male who says he's in pain being taken more seriously by healthcare professionals and therefore acted upon [rather] than the weak little woman in the corner who is complaining about pain, and she's just had major surgery as well. She's often thought of as weak and not being able to tolerate pain or overstating her pain level."

Another member of the WHAC, Dr. Daihnia Dunkley, whose background is in maternal child health and labor and delivery, said it's been disturbing to see how differently female pain is perceived — and underprescribed. "There's an implicit bias there between the two sexes when it comes to pain management," Dunkley said.

The pain gap is even worse for Black women

In a 2016 study, half of medical students and residents believed one of the three erroneous beliefs: "Black people's nerve endings are less sensitive than white people's"; "Black people's skin is thicker than white people's"; "Black people's blood coagulates more quickly than white people's." These kinds of false perceptions, Dunkley said, need to be addressed during medical education and training so they aren't perpetuated further.

According to Allison-Ottey, the change in treatment between Black women and white women can sometimes be understood by implicit bias. It may not be that a doctor or healthcare provider is racist, but they're surrounded by the stigma of the Black patient coming into the emergency room with drug-seeking behavior. "Really, they're in excruciating pain and you want to give them extra strength tylenol, but that same person in the next room who's white is getting hydrocodone," Allison-Ottey said.

If she were to advise other women, Finney said she would tell them to talk to their doctors and anesthesiologist and create a plan for pain management before heading into surgery. If possible, she says, it's best to bring someone with you who can understand the plan and advocate for you because it can be difficult, and sometimes impossible, to advocate for yourself when you've just undergone surgery. And, she said, don't be afraid to use your voice.

"Remember it is your right to ask as many questions as you need because you deserve to feel comfortable with the plan," Finney said. "I think sometimes any of us can get intimidated and think the doctors and nurses know best. It's your right to ask questions. It's their job to answer those questions."