What is pain?

A quick glance in the dictionary might help you with pain's physical attributes, but to really get to grips with an intensely complex, psychologically driven phenomenon, Merriam Webster won't be much use.

Pain is a controversial subject

Why? Well, for a start, as with anything that comes out of the human brain, it's subjective. What might be painful for one person might not be to someone else and this can depend on a variety of factors, such as general tolerance, previous experience of pain and also your personal definition of it.

Think back to adolescent philosophy sessions, where you wondered whether you saw the colour yellow in the same way as your friends did, or whether someone in the group's estimation of 'yellow' was closer to how you saw 'blue.' It's a bit like that. There's no guarantee that the way we experience things is the same as the next person.

Secondly, a doctor can arguably only diagnose or treat a patient on the basis that they trust their description of 'pain' to be accurate. So, the treatment of pain, is also open to subjectivity.

Troy AosseyGetty Images

And why is this bad for women?

Unfortunately for women, when it comes to subjectivity, we've historically gotten a pretty raw deal.

With centuries-old stereotypes about women being 'hysterical' or dramatic still, sadly pervasive today, the trust in our descriptions of how things feel or what we're experiencing can be lacking.

Case in point: The Independent published research showing that in A&E, when women and men present the same severity of abdominal pain, men wait an average of 49 minutes before being treated while, on average, women wait 65 minutes.

A 2008 National Institute of Health study found that women were 13-25 per cent less likely to receive opioids when they're suffering. Even less likely if the women were non-white caucasian. But that's a whole other article.

In Abby Norman's latest memoir, Ask Me About My Uterus , she delves into the complicated nature of pain. After repeated attempts to be diagnosed and treated for endometriosis, she slowly realised there's a gender bias in medicine that's affecting the way women are treated. We consulted her about the still-problematic issue of women's pain.

The issue is two-fold, she explains. Firstly, as we've already identified, even if the bias is unconscious, women are perceived to be prone to exaggeration.

The 'nervous' female condition

The female anatomy has longed bamboozled physicians. Heck, in the 17th Century, the uterus was widely thought to be like a rubber ball, often referred to as the ‘wandering womb’.

The concept of 'hysteria,' coined by neurologist Sigmund Freud in the 19th Century, was seen as a uniquely female trait.

Derived from the Greek word hystera, meaning uterus, hysteria was once the go-to diagnosis for any inexplicable illness experienced by a woman.

Freud once famously described his patient ‘Annie O’ – who suffered from paralysis, involuntary eye movements and hydrophobia – as ‘nervous’ and excessively emotional.

As a result, Norman believes the medical community’s qualification of women's pain over the years has been coloured by this archaic view of the female 'condition'.

‘Even before it had a name, the concept of what hysteria would become was integral to how women were perceived,' she explains in the book. 'They were emotionally labile to a pathological degree, or vulnerable to demonic possession or other manipulation by unseen evils.’

In other words, women were confusing, overly-emotional creatures who probably made a lot of stuff up.

'Don't Worry, It's Nothing'

As a counterbalance to the fact that we're seen to be melodramatic, many women will be bred to understate the experience of pain.

Think of how many times you’ve downplayed your period pain, boob soreness or headaches because you didn’t want to be seen as weak, over-the-top or, worse still, a 'girl'.

‘I was definitely taught to conceal my pain or play it down,' Norman tells ELLE UK. 'I was actually told on many occasions, when I was ill or hurt, to just “talk myself out of it” and that’s pretty much what I did from childhood into my early young adult years.’

'We’ve fainted, vomited, bled, laughed, screamed, and cried — and said, “I’m sorry, I don’t know what came over me,”' Norman writes in her book, 'when we know damn well, deep down, exactly what came over us: a wave of nausea, crushing fatigue, disorienting dizziness.'

Women's Troubles

Pain being subjective, coupled with conditions that only occur among people with female reproductive organs, can be a recipe for disaster, when it comes to getting a appropriate treatment.

Norman first noticed something was seriously wrong with her health when she collapsed in the shower at college with debilitating agony. ‘A stabbing pain in my middle, as though I were on the receiving end of an unseen assailant’s invisible knife,’ she describes in her book.

‘It felt like it was everywhere and nowhere all at once. It was almost as though something had snapped deep inside me.’

Throughout her journey to find a cure or diagnosis for her condition (she first began to feel endometriosis-specific symptoms aged 12), Norman has encountered plenty of doctors who doubt her account of it.

‘Every time I just get more and more convinced (despite the evidence to the contrary, like surgical photos showing actual disease in my body) that somehow they’re right and I’m wrong. That somehow I’ve made it all up even though I have proof right in front of me,' she says.

‘It goes from dismissal (“You’re fine”) to doubt (“It’s all in your head”) to blame, (“You’re doing this for attention”), and even if there is some kind of discussion about treating symptoms it’s often that the patient has to go through some kind of formal or more likely informal mental health assessment,' she continues.

She even recounts a situation with doctor who told her she must have been sexually abused as a child and that her symptoms were just her body's way of manifesting a psychological pain.

‘What’s most dangerous is not when a woman goes to a doctor and her pain is dismissed or disbelieved — it’s when it’s happened to her so many times that she stops speaking up. She stops going. She just decides she has to live that way and that she has no option. Not only does it put that woman’s life at risk, but it sets a precedent. It sends a message that the situation is hopeless,' concludes Norman.

Drazen_Getty Images

Moving forward

In the last few months, we've seen several women publish literature on female pain and it's potential for being missed or misdiagnosed.

In Maya Dusenbery’s book Doing Harm: The Truth About How Bad Medicine and Lazy Science Leave Women Dismissed, Misdiagnosed, and Sick, the author examines how women are overlooked in every area of illnesses.

Meanwhile, Michele Lent Hirsch’s book Invisible: How Young Women With Serious Health Issues Navigate Work, Relationships, and the Pressure to Seem Just Fine, delves into her own health issues and its impact on your career and relationships.

(Interestingly, Hirsch found a study which apparently provedhusbands are ten times more likely to leave women with brain tumours than wives are to leave their husbands).

In February, doctors claimed that the pain women experience during menstrual cramps is comparable to 'having a heart attack’.

And The National Institute for Health and Care Excellence (NICE) recently suggested that women with heavy periods should be first offered a hysteroscopy to find out the cause, instead of pelvic ultrasounds, because it is gives a more accurate diagnosis.

Finally, the tide is slowly turning.

But we need to do so much more.

'We need people outside of the chronic illness community to help,' Norman explains. 'Not only are we dealing with pain and other symptoms, but as patients, we’re bearing the burden to prove it, and even if we do, many of us have to reconcile the reality that there just aren’t that many treatments available, certainly nothing curative.

'We also need to advocate for awareness, for funding, for research. That’s a lot to ask or expect of anyone, but certainly those who are already struggling to meet basic expectations in their day to day lives.’

And lastly, we need all our female readers to feel brave enough to speak up. If you don't doubt your own experience of pain, stand tough in the face of people that do.