Sexism and Gender Bias in Pain Assessment and Treatment
Sexism and Gender Bias in Pain Assessment and Treatment
Growing up, gender bias was starkly apparent to me in how my pain as a person assigned female at birth (AFAB) was responded to. I was told that, like my pain, these biases were in my imagination. But as gender bias in pain assessment and treatment has been illuminated through research, confirmation of these biases is undeniable.
One such a study is a review of 77 articles pertaining to gender bias in pain treatment (Samulowitz et al. 2018). It was found that, in comparison to men, women were predominantly viewed by medical practitioners as more sensitive, likely to complain about pain, seek health care for minor issues or to be malingerers, and fabricate pain or be labeled as hysterical.
Women’s pain was more often attributed to psychological causes, while men were generally viewed as stoic and likely to seek healthcare only for important issues attributed to a somatic “real” cause by medical practitioners. Women also received less opioid medications and more antidepressant prescriptions and referrals for mental health interventions when seeking pain treatment, despite no apparent medical justification for these disparities.
Unsurprisingly, in another study women with a depression diagnosis who were tested and confirmed to be perceived as trustworthy were rated by health and medical practitioners as lower in trustworthiness when seeking pain care than men whose appearance had been previously tested and confirmed to be perceived as untrustworthy (Ashton-James and Nicholas 2016). Disbelief of women’s and AFABs pain among medical practitioners is especially prominent in “idiopathic” and “medically unexplained” or “contested” conditions, such as fibromyalgia, pelvic pain, and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), which predominantly affect women and AFABs, as does chronic pain in general (Dusenbery 2019).
Men and people assigned male at birth (AMAB) who have chronic pain conditions perceived to have more in common with diagnoses predominately given to women are frequently viewed as more feminine and subject to more biased pain assessments. These biases are linked to the phenomena of hegemonic masculinity and andronormativity (Samulowitz et al. 2018). Hegemonic masculinity is the privileging of attributes that are considered masculine such that people of any gender who deviate from these attributes are looked down upon and considered inferior. In andronormativity, masculine values dominate medicine and erase feminine values, thus defining what makes good practitioners or patients by male standards.
Sexist evaluations of pain are also evident in responses to pediatric pain. In a study of 264 college undergraduate students who observed a video recording of a five-year-old gender ambiguous child receiving a finger-stick to draw blood, students responded that the child was in more pain when told that the child was a boy than when the child was described as a girl (Earp et al. 2018). The student observers also rated the sensation and display of the pain as typical for a girl, when told that the child was female, but greater than what was considered typical for a boy when told that the child was male.
The research discussed here is only a small representation of findings of health and medical practitioner pain bias against women and AFABs (for landmark studies see: Hoffmann & Tarzian 2003, Werner & Malterud 2003). While there are indeed many gender differences in the perception, expression, and experience of pain, blatant medical sexism and discrimination is unconscionable. Women and AFABs who are of other marginalized positionalities, such as being BIPOC, disabled, in treatment for psychiatric conditions, and economically oppressed are subject to even greater prejudices.
Thank you for reading! Please check back for my next article about disability bias among health and medical practitioners, coming February 22, 2022.
For more about medical bias, read my posts:
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Sources
Dusenbery, Maya. Doing Harm: the Truth about How Bad Medicine and Lazy Science Leave Women Dismissed, Misdiagnosed, and Sick. HarperOne, 2019.
Earp, Brian D., et al. “Gender Bias in Pediatric Pain Assessment.” 2018, doi:10.31234/osf.io/pqg3a.
Hoffmann, D. E., & Tarzian, A. J. (2003). The Girl Who Cried Pain: A Bias Against Women in the Treatment of Pain. SSRN Electronic Journal. https://doi.org/10.2139/ssrn.383803
Samulowitz, Anke, et al. “‘Brave Men’ and ‘Emotional Women’: A Theory-Guided Literature Review on Gender Bias in Health Care and Gendered Norms towards Patients with Chronic Pain.” Pain Research and Management, vol. 2018, 25 Feb. 2018, pp. 1–14., doi:10.1155/2018/6358624.
Schäfer, G., Prkachin, K. M., Kaseweter, K. A., & Williams, A. C. (2016). Health care providers' judgments in chronic pain: the influence of gender and trustworthiness. Pain, 157(8), 16181625. https://doi.org/10.1097/j.pain.0000000000000536.
Werner, A., & Malterud, K. (2003). It is hard work behaving as a credible patient: encounters between women with chronic pain and their doctors. Social Science & Medicine, 57(8), 1409–1419. https://doi.org/10.1016/s0277-9536(02)00520-8.
