Big Girls Cry

Anjali Walia
Nov 5 · 3 min read

Three years ago, one of my close friends showed me her new medical cannabis card, which she had applied for on her 18th birthday. Responding to my concern, she explained that cannabis was her only relief from crippling pelvic pain that often kept her from attending classes. Her doctors told her it was “in her head” or “period pain” and prescribed her birth control medication, to little avail. It was two years later, after countless doctors’ visits and dean’s excuses for missed exams, that she was finally diagnosed with endometriosis and assured that her pain was real — that she wasn’t imagining it or being overdramatic.

Around the same time, I read Lena Dunham’s harrowing account of her lifelong journey with undiagnosed endometriosis, and was shocked by the parallels with my friend’s story. An online search led me to countless other tales of women chronicling their seemingly endless quests to have their pain acknowledged by doctors. Why must women struggle to have their pain taken seriously?

The rampant dismissal of women’s pain is shocking in light of the numerous studies showing that women, on average, experience pain that is more severe and longer lasting than that experienced by men. While the underlying reason for this disparity remains under investigation, one likely explanation is the different effects of estrogen and testosterone on the neurological process of pain perception. For example, studies have found that pain-reducing opioid receptors in the brain are less responsive in women than men and that the overall pain-modulating analgesic response is generally greater in men. Women are also more likely to suffer from painful inflammatory disorders such as fibromyalgia and arthritis, as well as autoimmune disorders associated with neuropathic pain.

Aside from biological factors, psychosocial circumstances can account for divergences in pain sensitivity between genders. Depression and anxiety are associated with decreased pain tolerance, and both are more prevalent among women. I often wonder if my never-complaining grandmother, who quietly suffered through years of debilitating pain due to arthritis, would have fared differently without the fear of being perceived as weak or overemotional. This gender stereotype still exists today. Gender differences in socially expected pain responses are difficult to study but nonetheless exert a significant effect on how women cope with pain.

Despite the considerable clinical and laboratory evidence establishing a significant difference in pain experienced by women and men, women remain undertreated for their pain. For example, countless women have suffered for years with undiagnosed endometriosis and polycystic ovarian syndrome due to dismissal of their symptoms. While women are frequently prescribed sedatives for pain after surgery, men are more likely to receive pain medications, and the wait time to receive such medication is considerably greater for women. Providers’ perceptions that women are overdramatic, or perhaps more resistant to pain due to our capacity for childbirth, may account for these health care disparities.

Poorly managed pain, although not considered a medical error, is not without consequences, as desperate sufferers like my friend can incur high health care costs, develop mental health disorders, or risk addiction to painkillers. The $1,999 mean cost per patient for poorly controlled pain after ambulatory surgery underscores the expense of pain mismanagement.

Eventually, a broad cultural rejection of the idea that women are overdramatic while men are strong is necessary to curb widespread dismissal of women’s health concerns. Studies involving pain must consider the influence of sex and gender, and we can direct our efforts to raising awareness of such differences in pain among the scientific and medical community.

Two current pilot projects supported by Women’s Health Research at Yale exemplify research efforts responding to women’s calls for effective pain treatment: one aiming to find non-addictive pain relief for women and another exploring the sex differences in cannabis use to treat pain. In addition, I recently attended a talk at Yale School of Medicine about the shift towards a “biopsychosocial approach to medicine,” which accounts for sociocultural factors affecting health.

Together, these developments give me hope that an overhaul of research and provider practices is underway. Ultimately, to ensure that all patients receive the treatments they need, caregivers must treat patients with compassion regardless of their identity.

Why Didn’t I Know This

A personal look at the history and current state of women’s health research from the undergraduate fellows of Women’s Health Research at Yale.

    Anjali Walia

    Written by

    Anjali is a junior Molecular, Cellular, Development Biology major in Saybrook who is passionate about women’s health and thrilled to write for the WHRY blog!

    Why Didn’t I Know This

    A personal look at the history and current state of women’s health research from the undergraduate fellows of Women’s Health Research at Yale.

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