Your doctor’s office should be a place of nurturing acceptance; a place where you can voice your medical concerns free of judgment and biased outcomes. You should be able to discuss the mundane just as well as the embarrassing unmentionables that make daily life hard to bear.
Ultimately, in that small, sterile exam room, you should feel confident that your pain is taken seriously, and you should trust that your doctor has an intimate understanding of the treatment they prescribe to you.
The operative word there is
There have long been disparities in the medical treatment of women. These lead to feelings of neglect, improper drug dosing, misdiagnoses and a general ignorance of the uniqueness of the impact a woman’s hormones and genetic makeup has on her body.
This type of misunderstanding leads to a host of problems for women, from exclusionary to fatal:
In 2013, the FDA recommended/approved lowering recommended Ambien doses for women. Since their bodies metabolized the medicine at different rates than men, next-morning impairment was leading to car accidents.
A 2016 study by Leeds University found that women are 50 percent more likely than men to receive an improper diagnosis after they’ve had a heart attack.
Women account for 75 percent of autoimmune disease diagnoses. It takes an average of 4.6 years and five doctors to receive the correct diagnosis. Black women are especially vulnerable, as they more often suffer from these diseases, especially lupus, which affects two to three times more women of color.
Women are more likely to receive sedatives instead of pain medication for ailments surrounding complaints of pain.
The average gap between initial symptoms and diagnosis of endometriosis is 8.6 years, during which time women see an average of three to five physicians before learning of the condition.
On average, women wait 65 minutes to receive an analgesic for acute abdominal pain. Men wait an average of 49 minutes.
"The Gender Pain Gap" was coined to describe and encompass these disparities in female healthcare and, clearly, there’s work to be done.
Part of the reason for the common mistakes made when dealing with female health is that the white male body has long been the model used in clinical trials and prescription drug dosages.
Historically, women have been discouraged from participating in clinical medical trials that investigate drug tolerability, dosages and side effects, as well as early evidence of efficacy.
Researchers and medical professionals have long cited potential harm to a developing fetus if the woman is pregnant (or does not know she’s pregnant), also claiming that fluctuations in the female hormone cycle make women more difficult and more costly to study.
The underrepresentation of diverse female body types in clinical testing has led to confusion and ignorance of the specific ways in which female hormones, size and even fat distribution affect how women metabolize medicine, how they experience pain and the types of diseases they are more prone to suffer from.
A 1977 FDA guideline (called the “General Considerations for the Clinical Evaluation of Drugs”) banning pregnant or potentially pregnant women from participating in early phases clinical trials acts as a concrete starting place for female exclusion in the U.S.
The clinical trials system continues to contain flaws, but there has been some progress, according to a timeline constructed by American Association for the Advancement of Science:
In the 1980s, “strong views” opposing the lack of female participation in clinical studies became more mainstream.
By the early 1990s, more focus was placed on including women in the early phases of clinical drug trials, allowing access to experimental therapies.
In 1993, the FDA reversed its previous stance that women of childbearing potential be omitted from clinical trials, when they published “Guideline for the Study and Evaluation of Gender Differences in the Clinical Evaluation of Drugs.”
True to its name, the Gender Pain Gap is especially harmful to women who are experiencing pain symptoms, be it singular instances or chronic pain.
To understand the effects of chronic pain that women endure, it’s important to also understand what chronic pain is. According to the National Institute of Neurological Disorders and Stroke, chronic pain is the type that persists:
“Pain signals keep firing in the nervous system for weeks, months, even years. There may have been an initial mishap — sprained back, serious infection, or there may be an ongoing cause of pain — arthritis, cancer, ear infection, but some people suffer chronic pain in the absence of any past injury or evidence of body damage…. Common chronic pain complaints include headache, low back pain, cancer pain, arthritis pain, neurogenic pain (pain resulting from damage to the peripheral nerves or to the central nervous system itself), psychogenic pain (pain not due to past disease or injury or any visible sign of damage inside or outside the nervous system). A person may have two or more co-existing [sic] chronic pain conditions. Such conditions can include chronic fatigue syndrome, endometriosis, fibromyalgia, inflammatory bowel disease, interstitial cystitis, temporomandibular joint dysfunction, and vulvodynia. It is not known whether these disorders share a common cause.”
Women not only receive more chronic pain diagnoses than men, but they also report more recurrent and severe pain, as well as pain that lasts longer than pain experienced by men.
When examining the experiences of women and their pain, there are countless existing narratives of ignored symptoms, symptom downplay by medical professionals and patients being told that their physical symptoms are in fact psychological, feeding the persistent idea of female hysteria. It is the resistance to taking female pain seriously that likely accounts for the fact that it takes longer for women to receive painkillers, if at all.
Often, they’re given sedatives instead.
Along with issues of pain, women are much more likely than men to receive an autoimmune disease diagnosis. Autoimmune diseases present puzzling questions for medical practitioners, but what they do know is that these diseases are ones that cause the body’s immune system to begin fighting its own cells. While men are also susceptible to these diseases, the female-to-male ratios of autoimmune disease diagnoses make it clear that women are more often the sufferers:
Hypothyroiditis/Hasimoto’s disease — 50:1
Systemic lupus erythematosus — 9:1
Sjögren’s syndrome — 9:1
Antiphospholipid syndrome — 9:1
Primary biliary cirrhosis — 9:1
Mixed connective tissue disorder — 9:1
Chronic active hepatitis — 8:1
The above are a mere few of some of the autoimmune diseases women suffer from, and it’s important to note that women of color experience their own unique rates of diagnosis. For example, black women are more likely than white women to have lupus, with one in 537 black women impacted. Additionally, one in three lupus patients also has one or more autoimmune diseases.
Given these facts, it’s important for healthcare practitioners to familiarize themselves with the unique needs of their female patients in order to help them live high-functioning and enjoyable lives in conjunction with their symptoms.
While we continue to wait on the medical industry to catch up on treating women, there are ways for women to take control of their medical visits and interactions with healthcare professionals. Here are five tips to help next time you visit the doctor’s office:
It’s easy to forget details when you’re at the doctor’s office. Bring notes that outline your specific symptoms, when they’re occurring and anything else that feels relevant so that you can give your doctor as much information as possible. It’s also helpful to bring a written list of prepared questions and a friend or partner who can offer you support and help keep you on track when interacting with healthcare professionals. Preparedness and encouragement will give you confidence during your exam.
If your doctor is relying on a lot of medical jargon to explain something to you, don’t beat yourself up for not understanding. Instead, ask for clarification and definitions. Along with understanding clinical vocabulary, make sure you fully understand and feel confident with your doctor’s diagnosis, proposed treatment plan and recovery timeline.
You know your body better than anyone. If you disagree with your doctor’s assessment, let them know. If you’re wary of arguing or are unable to see eye to eye, don’t be afraid to seek out a second or even third opinion.
It can feel embarrassing to openly talk about your medical concerns, but it’s extremely important that you honestly detail your symptoms to your doctor. Reminding yourself that they’ve likely encountered it before is helpful, and the more upfront you are during your initial visit, the less likely you are to have to return to your doctor’s office.
If you’re unable to reach a comfortable end point with your current doctor and are able to, visit another office. You’re not beholden to any one doctor, and finding one who you feel a connection with makes a huge difference in your medical care.
Going to the doctor’s office can be exhausting, emotionally and physically. Along with finding the time and resources to go, women can experience dismissal and downplay of their symptoms, leading to flawed treatment that can turn them off from future visits and ignoring medical concerns because of their past experiences.
With telemedicine services like hers, women can now take care of some of their minor health concerns from the comfort of their homes. We offer items like generic birth control, prescription skin care and hair loss products (among others) that come backed by our board-certified physicians and their discreet consultations with you.
The goal is helping each and every woman achieve the healthy lives they deserve, while finally putting the Gender Pain Gap to rest.