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In 2009 my doctor told me that, like “many women,” I was paying too much attention to my body. Telling me that he had no problem, he suggested that I relax and try to ignore the symptoms.
The decision seemed to go against what my health records showed. A few weeks before, I had been in the emergency room with chest pain and a heart rate of 220 beats per minute. The emergency team told me I had a panic attack, prescribed an anti-anxiety drug and told me to try to sleep.
I had had panic attacks before. I knew that this episode was not one of them, so I went to see my doctor. He put me a cardiac monitor.
Bingo: I had another episode, this time registered. But that did not matter. I left his office thinking that maybe I was suffering from anxiety. So, listening to the advice, I tried to ignore the pain.
Until it happened again. And again. First every month, then every week. For the next nine years, I was complaining about this and they told me I had panic attacks and anxiety , that women do not feel the pain of heart the way I felt and that maybe I was just confused.
My experience was not uncommon. Abby Norman, author of the book “Ask Me About My Uterus,” went through a similar process and ended up finding that she was suffering from endometriosis, a painful condition in which the endometrial tissue grows in other organs than the uterus.
Several doctors told her that she had a urinary tract infection, until she went to a medical appointment with her boyfriend, who attested to her pain.
Norman says she also struggled to be diagnosed with appendicitis. A doctor said that her symptoms were the result of having suffered sexual abuse during her childhood, even though she was sure she never suffered such things.
Both anecdotes and academic research point to a worrisome trend: in the health system there is a long tradition of dismissing women’s pain .
It is more difficult to determine if this is due to a prejudice based on gender, insufficient medical research on women or real differences in how both sexes interpret pain.
Different treatment in emergency rooms
What we know is that in relation to pain, men and women are treated differently.
One study, for example, found that in emergency rooms, women who say they suffer from acute pain are less likely to be treated with opioid-based analgesics (the most effective) than men . Then, after receiving the medical prescription, the women wait for a longer period to receive them.
Another study found that women are usually taken less seriously than men in emergency rooms. A study conducted in Sweden in 2014 found that once they are there, women wait longer to see the doctor and their cases are classified as urgent less frequently.
This can have deadly consequences. Last May, a 22-year-old woman called emergency services in France saying she had such severe abdominal pain that she felt she was “going to die.”
“You will undoubtedly die some day, like everyone else,” the operator replied. When she was taken to the hospital after a five-hour wait, the woman suffered a heart attack and died from the failure of multiple organs.
Esther Chen, specialized in emergency medicine at San Francisco General Hospital and author of a study on opioid-based analgesics, points out that the differential treatment of women in emergency rooms is a well- proven phenomenon but it is difficult to know if it is simply an implicit bias.
After conducting a study on acute abdominal pain, this doctor suspects that it is often assumed that women who come to emergency with abdominal pain have gynecological problems , something that doctors believe is less susceptible to being treated with opioids than an acute surgical disease. .
At the same time, when they go to the emergency rooms with pain, women are more likely than men to be treated with anti-anxiety medications and are more often dismissed as psychiatric patients.
“Women are referred to the psychologist or psychiatrist more regularly, while men are given diagnostic tests to rule out real problems in their body organs,” says Christin Veasley, co-founder and director of the Alliance for Research Chronic Pain (CPRA, for its acronym in English).
As the former executive director of the National Association on Vulvodynia, Veasley witnessed an alarming record of poor medical diagnoses.
“The things that I heard doctors say to women were completely ridiculous, things like ‘you must have marital problems’, ‘have a glass of wine before sex’, ‘it will be better’, and the list goes on,” points out
“It’s hard to imagine that a professional doctor who made the Hippocratic oath could say those things,” he says.
There is a common assumption that women complain more easily about health problems than men.
In fact, a study in the United Kingdom found, for example, that men’s attendance at the general practitioner is 32% lower than that of women. It is possible, therefore, that doctors consider reports of women’s pain less serious.
But there is other evidence to suggest that it is wrong to assume that women are more likely than men to complain about the same pain . A meta-analysis of studies on two common types of pain – back and head pain – found that men and women are equally likely to go to the doctor for these reasons.
The evidence that women go to the doctor more easily “is surprisingly weak and inconsistent, ” the researchers wrote.
Another similar study revealed that women are not more likely than men to go to the general practitioner when they suffer the same symptoms of pain.
Despite this, many researchers point out that there are studies conducted between 1972 and 2003 that indicate that women have lower tolerance to pain than men, something stimulated – of course – by cultural norms on gender.
Karen Sibert, president of the Society of Anaesthesiologists in California, points out that there is research that reveals that women have symptoms that are more like anxiety and have a greater tendency to become addicted to opiates.
As a result, it may be appropriate to treat women first with anti-anxiety medication before taking additional steps with the use of analgesics.
“When people are anxious their pain tolerance is reduced, it might be better to try to get their anxiety and fear under control first and then figure out how to treat their pain,” says Sibert.
Another complication is that estrogen alters both the perception of pain and the response to analgesics, says Nicole Woitowich, director of education at the Women’s Health Research Institute.
That means that there are “sexual differences in the way women experience pain,” says the expert who advocates a differentiated treatment to develop a personalized approach to the treatment of the patient.
Sex as a variable biol Ogică
To know exactly what those differences are-and how they affect the treatment-much more research is needed.
Before 1990, clinical trials and diagnostics in the United States were focused on men . In Europe, women had also been left out of school.
This led to the existence of a large amount of medical evidence, including studies focused on pain, that had a predominantly male perspective.
In 2015, the National Institutes of Health of the United States (NIH) approved a policy that required medical researchers to take sex into consideration as a biological variable .
Now, anyone who requires resources to investigate from the NIH must include both men and women or give a convincing explanation about why they are leaving out either.
As it is a recent policy, we still have to wait to assess its impact.
In Canada and Europe there have been similar changes. However, that does not eliminate the innate biases that doctors and other health workers have towards women’s pain.
As for me, Louise Pilote of the Health Center at McGill University in Quebec has an evidence-based explanation of why my own heart problems were postponed for so long.
Heart disease is more prevalent in men than in women, in those who are older and, when they do, usually show symptoms other than chest pain.
In fact, I was mainly concerned about how I felt as a result of the chest pain: dizzy, out of breath. I can understand why a doctor could have considered it just an anxiety problem.
In January 2018, I finally found a solution through a different cardiologist: a woman who listened and did not explain my pain only as a side effect of worry and anxiety . I went back to using a heart monitor, I received an official diagnosis and in March I had an operation.
Maybe I waited almost 10 years for the treatment because heart disease is less common in women.
Or maybe because my symptoms really were very similar to what the anxiety manuals describe or, also likely, that it was due to assumptions based on gender differences according to which women are more likely to complain about the pain and it is less possible that they have a physical reason for it.
But, even believing that my genre has everything to do with what happened, I’m not sure that one day it can be proven. And that the only thing that tells me is that we have a long way to go before women and their pain can be fully understood.