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15 Articles in Volume 18, Issue #5
Chronic Pelvic Pain: The Need for Earlier Diagnosis and Diverse Treatment
Cross-Linked Hyaluronic Acid for the Management of Neuropathic Pelvic Pain
Fentanyl: Separating Fact from Fiction
Gender Bias and the Ongoing Need to Acknowledge Women’s Pain
Letters to the Editor: 90 MME/day Ceiling; Ehlers-Danlos; Redefining Pain
Post-Menopausal MSK Pain and Quality of Life
PPM Welcomes Dr. Fudin and Dr. Gudin as New Co-Editors
Practitioner as Patient: Understanding Disparities in CRPS
States Take Action to Manage Opioid Addiction
Step-by-Step Injection Technique to Target Endometriosis-Related Neuropathic Pelvic Pain
The Many Gender Gaps in Pain Medicine
The Need for Better Responses to Vulvar Pain
Topical Analgesics for Chronic Pain Conditions
Topical Medications for Common Orofacial Pain Conditions
What’s the safest, effective way to taper a patient off of opioid therapy?

Gender Bias and the Ongoing Need to Acknowledge Women’s Pain

Inside the history of sex, gender, women, and pain - a perspective from the Society for Women's Health Research


Many women who suffer from chronic pain conditions say their pain has not been believed or taken seriously by family, friends, and even healthcare providers. In my role as president and CEO of the Society for Women’s Health Research (SWHR), I have heard from several women with such stories, and one of SWHR’s goals is to end this alarming bias.

One woman shared that her failed marriage stemmed from her husband not believing that her endometriosis was a real disease that caused life-altering, severe pain. Another woman described visiting doctor after doctor, while none took her complaint about painful sex seriously until she brought her male partner along to corroborate.

These intelligent, determined women were victims of a longtime gender bias in medicine, which includes the stigmatization and normalization of women’s pain. They did not give up. Instead they continued to advocate for themselves until they got the medical care they needed. But many women are not as persistent, and no woman should have to face this struggle in the first place.


A Long Road Back

Sex and gender bias has its roots in the way medical research was conducted for centuries — by simply assuming women’s biology was the same as men’s and excluding women from research. As recently as 25 years ago, women of reproductive age were actively excluded from most clinical trials.1 Researchers feared possible harm to potential pregnancies and thought that female hormonal cycles were too challenging to manage in experiments. Because of this exclusion, we are facing a huge gap in knowledge about women’s health.

Pain research, in particular, has been dominated by male animals and humans. Nearly 80% of animal studies published in the journal Pain from 1996 to 2005 used only male subjects.2 This occurrence is quite puzzling given that women are more likely to have chronic pain than men.

With society often dismissing women’s pain and a relatively brief record of research inclusive of women, it is unsurprising that many of the chronic pain conditions for which we do not have direct treatments are more common in or exclusively affect women. Recognizing this as an area of great need in women’s health, SWHR has recently started scientific programs that focus on two such chronic pain conditions: migraine and endometriosis.

For these conditions and others, such as uterine fibroids, polycystic ovary syndrome (PCOS), and fibromyalgia, current treatment options aim to alleviate symptoms, such as reducing pain. We need a shift in thinking: Instead of just treating the pain, incentives should be put in place to encourage development of innovative therapies that directly treat, prevent, or cure the painful condition. For example, medicines are now being designed specifically to prevent migraine.

While developing these sorts of new solutions, it is crucial that scientists recognize and address the clear differences in how women and men experience pain.3 Studies show that women are at significantly higher risk for many common pain conditions, report pain more frequently than men, and have greater sensitivity to pain. Yet the underlying mechanisms for these differences remain largely unknown. In addition, women and men are often treated differently for pain, leading to disparities in pain management.

Because of the sex differences described, it is vital that women be properly represented in all phases of clinical trials and that data are analyzed by sex to identify any differences in treatment efficacy and safety between women and men.

SWHR was founded in 1990 to advocate for the inclusion of women and minorities in clinical trials and saw its first major victories in 1993 when both the National Institutes of Health (NIH) and the Food and Drug Administration (FDA) changed their policies to begin to move in the right direction. NIH mandated the inclusion of women and minorities in clinical trials and FDA lifted its restriction on women of childbearing potential in early phase drug studies.4,5

Let’s Not Repeat History

While progress has been made to include women in clinical research, much more needs to be done to ensure adequate levels of participation by women from a diversity of backgrounds. Efforts must focus on eliminating the barriers that hinder the recruitment and retention of women in clinical trials, including lack of awareness of clinical trials among patients and physicians. Getting more women into clinical trials will require greater, targeted outreach to women who are patients and educating healthcare providers to better understand women’s pain.

Keeping the patient experience at the forefront of our thinking in developing new therapies and designing clinical trials is critical to success. Only by taking a patient-focused approach can we hope to start closing the research gap in women’s health and finding effective innovations that address the disease, not just the pain symptoms.

An even greater challenge, however, may be overcoming the ingrained biases in our society that have led to stories like the ones I’ve shared above — of women whose pain is not taken seriously. This stigma around women’s pain requires a concerted effort by the medical community to improve the education of healthcare providers in recognizing and treating women’s pain in order to overcome historical biases.

As one expert at SWHR’s recent congressional briefing on endometriosis said, there are long-term consequences when a woman’s pain isn’t believed: “That changes who these young women are and what they think they can achieve and how they choose to move forward with their lives.”6


Also featured in this special report on Pain Care & Research in Women

Last updated on: August 7, 2018
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The Many Gender Gaps in Pain Medicine
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