By Aditi Adapala and Erin Fitzpatrick, Lynbrook High School, San Jose, California, USA
Summary
Even with increasingly advanced medical technologies, there are still disparities in the care provided to men and women. Despite women being shown to experience more severe and longer fits of pain, concerns are often neglected and underemphasized. Doctors are more likely to give antidepressants rather than painkillers to female patients, suggesting that women’s pain is seen as psychological. When asked the question of why this occurs, some professionals turn to explanations such as the Yentl syndrome, a phenomenon in which women must prove that their pain is worse than a man’s before ever receiving treatment. This issue lies in flawed studies that did not have adequate sample populations of females. This discrepancy leads to treatments being approved that are unable to help women. Addressing these gaps in care needs to be at the forefront of efforts in the medical world.
As the world moves forward into a more modern age, the healthcare system has improved exponentially. Giving birth is almost 300 times safer than it was previously; diseases such as tuberculosis, previously considered incurable, are now easily treatable (Roser & Ritchie, 2013). But moving further into the modern world has shed light on the widening gaps in treatment between men and women. It has been shown time and time again that the healthcare system has failed in regards to pain management for women (Hoffmann & Tarzian, 2003). According to the study “The Influence of Gender on the Frequency of Pain and Sedative Medication Administered to Postoperative Patients”, women are often prescribed sedatives, rather than pain medication. This indicates that doctors often see women's pain as psychological rather than physical (Calderone, 1990). The difference in treatment boils down to sexist stereotypes. Women are prescribed with antidepressants, non-opioid analgesics, and even tranquilizers more often, which suggests that women’s pain is seen not as pain, but rather as hysteria and overdramatization. In contrast, men are often prescribed with opioids (strong painkillers), indicating that men’s pain is seen as more valid (Lack, 1982).
A paper published in Social Science Research Network called “The Girl Who Cried Pain: A Bias Against Women in the Treatment of Pain” explores factors that might explain the difference in pain treatment between men and women (Hoffmann & Tarzian, 2003). The article discusses review articles that examined the biological differences between the sexes' pain tolerance (Hoffmann & Tarzian, 2003). The review articles found that most, if not all of the studies, concluded that women felt more severe, frequent, and longer durations of pain (Unruh, 1996). It was also found that, in a study published by the New England Journal of Medicine, “Pain and Its Treatment in Outpatients with Metastatic cancer,” of the 42 percent of 1,308 outpatients that were under-medicated for their pain, women were more likely to be under-treated with an odds ratio of 1:5 (Cleeland et al., 1994). Gender discrimination also does not differ with age. The study “Patterns of Postoperative Analgesic Use with Adults and Children” noted that during the postoperative period among children, girls were more likely to be prescribed acetaminophen rather than codeine, while boys were most often prescribed codeine (Beyer et al., 1983).
The Yentl syndrome is a phenomenon in which women are misdiagnosed and inadequately treated unless their symptoms conform to the standards based on their male counterparts. The name “Yentl Syndrome” originates from the 1983 blockbuster film Yentl, where a young woman disguises herself as a man to continue her education (Longreads. 2019).
Since 1989, cardiovascular disease has been the leading cause of death for women in the U.S (CDC, 2017). According to the ESC, both long and short-term survival rates between men and women show significant differences. At 30 days after complications, 38% of women were alive in comparison to 50% of the men. At 8 years, 27% of the women were alive compared to 39% of men (Antipolis, 2022). This long-standing issue has a simple answer: doctors failing to recognize at-risk women. Prediction models that are commonly used to diagnose health issues are almost always developed in patient populations that are male dominated. Most prediction models fail to accommodate for the symptoms that women experience, meaning women are being drastically unaccounted for (Longreads, 2019). For example, during a heart attack women may present with symptoms like breathlessness or fatigue, which are regarded as “atypical” or unusual presentations (Barouch, 2023). Men, however, often have symptoms that fall under the prediction model umbrella such as chest and left arm pain (Barouch, 2023). Because of this, women are being misdiagnosed, which puts them at higher risk for complications down the line.
Misconceptions surrounding women's pain can be attributed to the way clinical studies are conducted. According to the article “Sex Inequalities in Medical Research: A Systematic Scoping Review of the Literature,” most studies on major health conditions, the effectiveness of medicines, and even the typical symptoms are based on the reactions of men (Merone et al., 2022). Often, women will present with different sets of symptoms than men (Barouch, 2023). However, because most modern-day medicine is taught based on studies and review literature done mostly on white men, the symptoms of women and people of color can often be overlooked and unrecognized (Merone et al., 2022). A study done in 2009 showed Acetylsalicylic acid (Aspirin) was found to be effective in preventing heart attacks (Baigent et al., 2009). However, after further investigations were carried out by the Women's Health Study, it was found that the original paper failed to incorporate enough women into the study population. The Women's Health Study showed that aspirin had nonsignificant effects on women aged forty-five and sixty-five (Gersh, 2006).
Even as healthcare improves, the gap in care provided for men versus women becomes wider. We can resolve this issue by encouraging healthcare providers to reflect on their prescription choices, promote the empowerment of women, and enact policies to champion equality. Perhaps at one point in time it was just women living in a man’s world, but the time for change is now.
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