tag:theconversation.com,2011:/us/topics/womens-pain-22826/articleswomen's pain – The Conversation2024-01-31T19:08:10Ztag:theconversation.com,2011:article/2217472024-01-31T19:08:10Z2024-01-31T19:08:10ZA new government inquiry will examine women’s pain and treatment. How and why is it different?<figure><img src="https://images.theconversation.com/files/572314/original/file-20240131-25-o9jwvw.jpg?ixlib=rb-1.1.0&rect=25%2C12%2C4228%2C2812&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/older-woman-massaging-tensed-rubbing-muscles-2365171835">Shutterstock</a></span></figcaption></figure><p>The Victorian government has announced an <a href="https://www.health.vic.gov.au/inquiry-into-womens-pain">inquiry</a> into women’s pain. Given women are disproportionately affected by pain, such a thorough investigation is long overdue. </p>
<p>The inquiry, the first of its kind in Australia and the first we’re aware of internationally, is expected to take a year. It aims to improve care and services for Victorian girls and women experiencing pain in the future.</p>
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Read more:
<a href="https://theconversation.com/there-is-overwhelming-gender-bias-in-the-ndis-and-the-review-doesnt-address-it-220042">There is overwhelming gender bias in the NDIS – and the review doesn't address it</a>
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<h2>The gender pain gap</h2>
<p>Globally, more women report chronic pain than men do. A survey of over 1,750 Victorian women found 40% are living with chronic <a href="https://www.premier.vic.gov.au/gender-pain-gap-revealed-and-women-arent-surprised">pain</a>. </p>
<p>Approximately <a href="https://pubmed.ncbi.nlm.nih.gov/36038207/#:%7E:text=About%20half%20of%20chronic%20pain,a%20higher%20prevalence%20in%20men.">half of chronic pain conditions</a> have a higher prevalence in women compared to men, including <a href="https://academic.oup.com/painmedicine/article/22/2/382/5961453">low back pain</a> and <a href="https://www.mdpi.com/2077-0383/10/14/3178">osteoarthritis</a>. And female-specific pain conditions, such as endometriosis, are much more common than male-specific pain conditions such as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3894747/">chronic prostatitis/chronic pelvic pain syndrome</a>. </p>
<p>These statistics are seen <a href="https://www.abs.gov.au/statistics/health/health-conditions-and-risks/stressors-and-bodily-pain/latest-release">across the lifespan</a>, with higher rates of chronic pain being reported in females <a href="https://www.sciencedirect.com/science/article/pii/S0304395911004751?casa_token=fDkFvlrL930AAAAA:SonUMuMgqohViJ2Ok9gGQ7K4G0hChxZYolroR7t5LVSd_uzMnSe_2EBZ4b8blh3GscewZ1bI7Ac">as young as two years old</a>. This discrepancy <a href="https://www.aihw.gov.au/reports/chronic-disease/chronic-pain-in-australia/summary">increases with age</a>, with 28% of Australian women aged over 85 experiencing chronic pain compared to 18% of men. </p>
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Read more:
<a href="https://theconversation.com/people-with-endometriosis-and-pcos-wait-years-for-a-diagnosis-attitudes-to-womens-pain-may-be-to-blame-179500">People with endometriosis and PCOS wait years for a diagnosis – attitudes to women’s pain may be to blame</a>
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<h2>It feels worse</h2>
<p>Women also experience pain differently to men. There is some evidence to suggest that when diagnosed with the same condition, women are more likely to report <a href="https://www.sciencedirect.com/science/article/pii/S1526590011008728">higher pain scores than men</a>. </p>
<p>Similarly, there is some evidence to suggest women are also more likely to report higher pain scores during experimental trials where the same painful pressure stimulus is applied to <a href="https://www.sciencedirect.com/science/article/pii/S0304395911007019?casa_token=ZK8PjH4pXUYAAAAA:UI8K8sKlrWM3OCC7qBucplrA-mct4EU5NZUpQsLQ6WooNWlfxC6MCtTdTKmtyQYjh9kcE08okiQ">both women and men</a>. </p>
<p>Pain is also more burdensome for women. Depression is twice as prevalent in women with chronic pain <a href="https://www.sciencedirect.com/science/article/pii/S0033318207710022">than men with chronic pain</a>. Women are also more likely to report <a href="https://journals.lww.com/spinejournal/FullText/2007/05200/Sex_Differences_in_Consequences_of_Musculoskeletal.17.aspx?casa_token=mgToFxqQuiwAAAAA:Plx0N_ILNIVK_D8NDODFYaYi_HDxbZN2enulMAS0VmIwyCNHd3c62lhEDi_AYDw8Dhz7uX2dPIZ3HoqwnuWoanLH">more health care use</a> and be <a href="https://www.aihw.gov.au/getmedia/10434b6f-2147-46ab-b654-a90f05592d35/aihw-phe-267.pdf.aspx">hospitalised due to their pain</a> than men. </p>
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<a href="https://images.theconversation.com/files/572316/original/file-20240131-16-pjgp8g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="woman lies in bed in pain" src="https://images.theconversation.com/files/572316/original/file-20240131-16-pjgp8g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/572316/original/file-20240131-16-pjgp8g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/572316/original/file-20240131-16-pjgp8g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/572316/original/file-20240131-16-pjgp8g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/572316/original/file-20240131-16-pjgp8g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/572316/original/file-20240131-16-pjgp8g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/572316/original/file-20240131-16-pjgp8g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Women seem to feel pain more acutely and often feel ignored by doctors.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-woman-having-stomach-ache-on-1780468907">Shutterstock</a></span>
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Read more:
<a href="https://theconversation.com/whats-a-tens-machine-can-it-help-my-period-pain-or-endometriosis-201389">What's a TENS machine? Can it help my period pain or endometriosis?</a>
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<h2>Medical misogyny</h2>
<p>Women in pain are viewed and treated differently to men. Women are more likely to be told their pain is psychological and dismissed as <a href="https://www.tandfonline.com/doi/full/10.1080/03630242.2017.1306606?casa_token=twusk7mU5EcAAAAA%3AG--5Y_nl_bDqsR9k4w-fF8sEMGuGiMlrifAGQKC_j6swOBhYdzzwXeXiNUoR4C9vM2CydSppwLN2">not being real or “all in their head”</a>.</p>
<p>Hollywood actor <a href="https://www.independent.co.uk/life-style/health-and-families/selma-blair-ms-misdiagnosis-symptoms-b2454317.html">Selma Blair</a> recently shared her experience of having her symptoms repeatedly dismissed by doctors and put down to “menstrual issues”, before being diagnosed with multiple sclerosis in 2018. </p>
<p>It’s an experience familiar to many women in Australia, where medical misogyny still runs deep. <a href="https://journals.sagepub.com/doi/abs/10.1177/09593535221083846?journalCode=fapa&">Our research</a> has repeatedly shown Australian women with pelvic pain are similarly dismissed, leading to lengthy diagnostic delays and serious impacts on their quality of life. </p>
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<h2>Misogyny exists in research too</h2>
<p>Historically, misogyny has also run deep in medical research, including pain research. Women have been viewed as smaller bodied men with different reproductive <a href="https://www.sciencedirect.com/science/article/abs/pii/S156925580334024X">functions</a>. As a result, most pre-clinical pain research has used male rodents as the default research <a href="https://journals.lww.com/pain/fulltext/2005/09000/the_case_for_the_inclusion_of_female_subjects_in.1.aspx?casa_token=BcqYDDSRxo4AAAAA:nLvLqpNfuwSm6N4n1kn-Wcj4n9HW__ISaNz57PYp0zX8Nfu9a5cWZdJkjCXVXeU_HKjraI5NbND-rqqzanYuF864">subject</a>. Some researchers say the menstrual cycle in female rodents adds additional variability and therefore uncertainty to experiments. And while variability due to the menstrual cycle may be true, it may be no greater than male-specific sources of variability (such as within-cage aggression and dominance) that can also <a href="https://www.nature.com/articles/s41583-020-0310-6">influence research findings</a>. </p>
<p>The exclusion of female subjects in pre-clinical studies has hindered our understanding of sex differences in pain and of response to treatment. Only recently have we begun to understand various genetic, neurochemical, and neuroimmune factors contribute to sex differences in <a href="https://www.annualreviews.org/doi/full/10.1146/annurev-neuro-092820-105941">pain prevalence and sensitivity</a>. And sex differences exist in pain processing itself. For instance, in the spinal cord, male and female rodents process <a href="https://theconversation.com/pain-really-is-in-the-mind-but-not-in-the-way-you-think-1151">potentially painful stimuli</a> through <a href="https://www.nature.com/articles/nn.4053">entirely different immune cells</a>. </p>
<p>These differences have relevance for how pain should be treated in women, yet many of the existing pharmacological treatments for pain, including opioids, are largely or solely based upon research completed on male rodents. </p>
<p>When women seek care, their pain is also treated differently. Studies show women receive <a href="https://link.springer.com/article/10.1007/s11916-023-01135-0#ref-CR6">less pain medication after surgery compared to men</a>. In fact, one study found while men were prescribed opioids after joint surgery, women were <a href="https://link.springer.com/article/10.1007/s11916-023-01135-0#ref-CR17">more likely to be prescribed antidepressants</a>. In another study, women were more likely to receive sedatives for pain relief following surgery, while men were <a href="https://link.springer.com/content/pdf/10.1007/BF00289259.pdf">more likely to receive pain medication</a>. </p>
<p>So, women are disproportionately affected by pain in terms of how common it is and sensitivity, but also in how their pain is viewed, treated, and even researched. Women continue to be excluded, dismissed, and receive sub-optimal care, and the recently announced inquiry aims to improve this. </p>
<h2>What will the inquiry involve?</h2>
<p>Consumers, health-care professionals and health-care organisations will be invited to share their experiences of treatment services for women’s pain in Victoria as part of the year-long inquiry. These experiences will be used to describe the current service delivery system available to Victorian women with pain, and to plan more appropriate services to be delivered in the future. </p>
<p>Inquiry <a href="https://www.health.vic.gov.au/public-health/inquiry-into-womens-pain-submissions">submissions</a> are now open until March 12 2024. If you are a Victorian woman living with pain, or provide care to Victorian women with pain, we encourage you to submit.</p>
<p>The state has an excellent track record of improving women’s health in many areas, including <a href="https://www.premier.vic.gov.au/groundbreaking-clinic-improving-womens-heart-health">heart</a>, <a href="https://www.health.vic.gov.au/publications/victorian-womens-sexual-and-reproductive-health-plan-2022-30">sexual, and reproductive health</a>, but clearly, we have a way to go with women’s pain. We wait with bated breath to see the results of this much-needed investigation, and encourage other states and territories to take note of the findings.</p><img src="https://counter.theconversation.com/content/221747/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jane Chalmers receives funding from The Hospital Research Foundation. </span></em></p><p class="fine-print"><em><span>Amelia Mardon does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Women are disproportionately affected by pain in terms of how common it is and sensitivity, but also in how their pain is viewed, treated, and even researched.Jane Chalmers, Senior Lecturer in Pain Sciences, University of South AustraliaAmelia Mardon, PhD Candidate, University of South AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2201792024-01-30T16:16:38Z2024-01-30T16:16:38ZEndometriosis takes almost a decade to be diagnosed in the UK — our research has revealed some of the reasons why<figure><img src="https://images.theconversation.com/files/572134/original/file-20240130-21-1iifrs.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5472%2C3637&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Endometriosis can cause severe chronic pain.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-asian-woman-relieves-stomach-pain-2199693477">Drazen Zigic/ Shutterstock</a></span></figcaption></figure><p>Around <a href="https://www.endometriosis-uk.org/sites/endometriosis-uk.org/files/files/Annual%20Report%202018.pdf">one in ten women</a> and people with uteruses in the UK have endometriosis. This disease causes tissue similar to the womb’s lining to grow in other places – such as the ovaries and fallopian tubes. This can cause chronic pain, difficulty getting pregnant, organ damage and fatigue.</p>
<p>Yet despite how common endometriosis is, people who have the disease still wait around <a href="https://www.annalsofhealthresearch.com/index.php/ahr/article/view/111">eight years on average</a> to be diagnosed.</p>
<p>There are numerous, <a href="https://journals.sagepub.com/doi/full/10.1177/0959353519826170">complex reasons</a> for this delay. A <a href="https://www.sciencedirect.com/science/article/abs/pii/S0002937819303850?via%3Dihub">lack of knowledge</a> about endometriosis by both those affected and healthcare professionals has been suggested, meaning those with symptoms may not know to ask for help – and those that do may receive poor quality care. </p>
<p>We wanted to better understand what barriers people continue to face when it comes to endometriosis care. We used interviews and an open-ended online survey to learn about these experiences. </p>
<p>A total of 33 women completed the online survey – 21 of whom were diagnosed with endometriosis, and 12 who were seeking a diagnosis. We also conducted in-depth interviews with four of the women who have been diagnosed with endometriosis.</p>
<p>Our research identified the <a href="https://www.tandfonline.com/doi/full/10.1080/10810730.2023.2299003">four main challenges</a> people faced in accessing endometriosis care: </p>
<h2>1. Systemic sexism</h2>
<p>Our participants described a health system tarred by systemic sexism. Experiences were characterised by doctors and nurses not believing them or thinking they were exaggerating. </p>
<p>One participant said: “I have been told that my pain was in my head or that I must have a low pain threshold.” </p>
<p>This led the participants to feel ashamed, embarrassed and powerless – making them less likely to seek out help in the future.</p>
<p>Many also reported feeling their concerns were dismissed as “women’s issues” that shouldn’t be discussed, with one interviewee revealing: </p>
<blockquote>
<p>I have no problem talking about menstruation and periods – but it is people’s and society’s reactions to the topic that makes me feel as though I cannot say anything. Almost as if it is a women’s issue that you must deal with quietly and alone. </p>
</blockquote>
<p>This also extended to their workplace, where some reported not being supported by management even after being diagnosed – and feeling pressure to return to work early after surgery.</p>
<h2>2. Long waiting lists</h2>
<p>Long waiting lists prevented participants from seeking help. And, many felt resigned to pay for private healthcare if they could afford it. Those who couldn’t were left “in the hands of the NHS”.</p>
<p>Nine participants reported paying for private tests or appointments. These participants saw this as the only way to get a diagnosis, with one interviewee revealing:</p>
<blockquote>
<p>When I raised endometriosis as a potential issue I was given the reply ‘I don’t know anything about that condition’ from the GP. Non-specialist gynaecologists also seem to misunderstand the condition and it was only when I recently went for a private consultation that I was believed and was told it’s highly likely that I have the condition.</p>
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<p>Others chose private care because they felt waiting any longer for NHS care would have had a serious impact on their mental health. </p>
<h2>3. Lack of treatment options</h2>
<p>Participants overwhelmingly reported they felt helpless about their treatment options – even after being diagnosed. As one interviewee put it:</p>
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<p>I feel helpless when I try to manage my pain. I feel overwhelmed and I can sit there for a while and just not know what to do. I feel like I have given up trying to manage my pain. I’ve noticed it has become part of my life and I am used to it, to the point where I don’t notice the mild discomfort anymore. I don’t think I even realised that a healthy person doesn’t have this constant pain.</p>
</blockquote>
<p>Others reported this helplessness stemmed from their experiences with healthcare providers. One participant even said her doctor made her feel that “surgery was pointless” – revealing that when she was offered surgery, she was told it would have little effect in managing her pain.</p>
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<img alt="A woman in pain speaks with a female doctor." src="https://images.theconversation.com/files/572137/original/file-20240130-29-84joju.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/572137/original/file-20240130-29-84joju.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/572137/original/file-20240130-29-84joju.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/572137/original/file-20240130-29-84joju.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/572137/original/file-20240130-29-84joju.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/572137/original/file-20240130-29-84joju.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/572137/original/file-20240130-29-84joju.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Some of the interviewees spoke of difficulty in getting help from their doctors.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/female-patient-holding-her-abdomen-pain-2256679083">Drazen Zigic/ Shutterstock</a></span>
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<p>Another participant stated that the “general ‘trial and error’ approach to my treatment made me feel mistrusting of the diagnosis process and subsequent treatment”.</p>
<h2>4. Self doubt and fatigue</h2>
<p>Having symptoms repeatedly dismissed and not believed by doctors led women to mistrust their own experience. They worried that even if they tried getting help, they wouldn’t receive the support they wanted anyway. Women reported intense and overwhelming fear and helplessness, feeling drained from being forced to advocate for themselves.</p>
<p>One woman told us, “I have totally lost faith in my own thoughts and feelings and feel genuinely terrified to try and speak to more doctors.” Another said, “I don’t have it in me to fight and advocate for myself anymore as it’s just so exhausting.” </p>
<h2>Need for change</h2>
<p>Having strong, trusting relationships with doctors is central to having a <a href="https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-019-0774-6">positive experience</a> in managing endometriosis and getting the right healthcare. When concerns are repeatedly dismissed, it can cause people with endometriosis to <a href="https://www.tandfonline.com/doi/full/10.1080/10410236.2022.2048468">avoid engaging</a> with the healthcare system altogether. Our research shows that these issues still remain problems today, contributing to delayed diagnosis and poor management of the disease. </p>
<p>Our findings suggest that we need cultural change. We need to de-stigmatise gynaecological health and change attitudes towards pain so that it’s no longer dismissed or normalised. </p>
<p>We also need better awareness of endometriosis and training for doctors and nurses so that diagnoses and treatment happen more quickly.</p>
<p>But until that systemic change happens, many people with endometriosis may still face obstacles in accessing care. If you suspect you have endometriosis, we advise keeping a “pain diary” – documenting when, where and how often your pain is happening so that you can provide your doctor with more detail on your experiences.</p>
<p>If you don’t feel like you’re being taken seriously, ask for a second opinion. There’s also lots of support available from national charities such as <a href="https://www.endometriosis-uk.org/">Endometriosis UK</a>, which can provide information on the condition, and also offer support groups and helplines for those affected.</p><img src="https://counter.theconversation.com/content/220179/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Endometriosis affects 10% of women in the UK.Jasmine Hearn, Senior Lecturer in Psychology, Manchester Metropolitan UniversityStella Bullo, Senior Lecturer in Linguistics, Manchester Metropolitan UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1818032022-04-26T15:33:24Z2022-04-26T15:33:24ZEndometriosis: pandemic backlog risks making it even harder for women to get help<figure><img src="https://images.theconversation.com/files/459817/original/file-20220426-22-cbbi79.jpg?ixlib=rb-1.1.0&rect=53%2C0%2C6000%2C3997&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">One in 20 UK women will now wait more than a year for an appointment.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/coronavirus-hospital-covid-19-woman-medical-1721906755">Elizaveta Galitckaia/ Shutterstock</a></span></figcaption></figure><p>The COVID-19 pandemic has had a <a href="https://www.rcog.org.uk/news/more-than-half-a-million-women-face-prolonged-waits-for-gynaecology-care/">disproportionate and devastating impact</a> on women’s health, according to a report from the Royal College of Obstetricians and Gynaecologists.</p>
<p>The <a href="https://rcog.shorthandstories.com/lefttoolong/index.html#group-section-Foreword-LiwE2VBZtN">report found</a> that more than half a million women in the UK have been forced to wait for “non-urgent” gynaecological care. Waiting lists across the country are now <a href="https://www.rcog.org.uk/news/more-than-half-a-million-women-face-prolonged-waits-for-gynaecology-care/">60% longer than pre-pandemic levels</a>. This means that one in 20 women will now be waiting more than a year to receive gynaecological surgery, specialist treatments and even diagnoses. </p>
<p>Some of those hardest hit by these delays are women suffering with <a href="https://ora.ox.ac.uk/objects/uuid:0b4cfc1d-79e9-4bee-8a4d-76ed21fa986f/download_file?safe_filename=Zondervan_et_al_Endometriosis_VoR.pdf&type_of_work=Journal+article">endometriosis</a>, the chronic inflammatory condition characterised by tissue similar to the womb lining growing elsewhere in the body – in places such as the ovaries or fallopian tubes. An estimated <a href="https://pubmed.ncbi.nlm.nih.gov/19196878/">one in ten women</a> have the condition, many of which live with excruciating pain. </p>
<p>If left untreated or poorly managed, the condition can worsen. This can make it far more challenging to treat, and may have a <a href="https://www.eshre.eu/Guidelines-and-Legal/Guidelines/Endometriosis-guideline.aspx">long-lasting impact</a> on the woman’s health – such as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2941592/">causing fertility problems</a> or worsened pain. </p>
<p>According to the report, the pandemic made it difficult for women with endometriosis to manage their condition and access the kind of specialist treatment they needed. For example, many women experiencing pain caused by endometriosis had to attend A&E for care because specialist care wasn’t available. And after this, many were referred to gynaecology services, which meant waiting up to <a href="https://www.rcog.org.uk/news/more-than-half-a-million-women-face-prolonged-waits-for-gynaecology-care/">five months for an appointment</a>.</p>
<p>For others, delays to care – such as surgeries to manage the condition – meant that not only did their pain worsen, the disease also progressed. This can have a serious effect on many aspects of a woman’s life, including their <a href="https://rcog.shorthandstories.com/lefttoolong/index.html">mental health</a> and <a href="https://www.brighamandwomens.org/obgyn/infertility-reproductive-surgery/endometriosis/endometriosis-and-fertility">fertility</a>. Some will also require more complex and invasive surgeries to manage their condition as a result.</p>
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<img alt="Woman sits on her bed, holding her stomach in pain." src="https://images.theconversation.com/files/459818/original/file-20220426-26-idiyh1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/459818/original/file-20220426-26-idiyh1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/459818/original/file-20220426-26-idiyh1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/459818/original/file-20220426-26-idiyh1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/459818/original/file-20220426-26-idiyh1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/459818/original/file-20220426-26-idiyh1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/459818/original/file-20220426-26-idiyh1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Being unable to manage pain left some women feeling isolated.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-african-american-woman-feeling-stomach-2080313062">Prostock-studio/ Shutterstock</a></span>
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<p>Being unable to get the care they needed to manage their pain effectively left many women feeling isolated and unable to go about their normal life. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5440042/">Poor mental health</a> was already a problem for women with endometriosis even before the pandemic. But more than 80% of women surveyed as part of the report said their mental health worsened during the pandemic, largely because of their pain but, not uncommonly, also because they felt they were being dismissed. </p>
<h2>Looking forward</h2>
<p>Gynaecology services are one of the surgical specialities <a href="https://nhswaitlist.lcp.uk.com">worst hit</a> by COVID-19 backlogs. Part of this is because, early in the pandemic, around half of gynaecology consultants were redeployed to obstetric care services. </p>
<p>Even with things slowly returning to how they were pre-pandemic, it’s likely that the backlog for gynaecology services won’t <a href="https://www.nao.org.uk/wp-content/uploads/2021/07/NHS-backlogs-and-waiting-times-in-England.pdf">decrease until 2025</a>. Given women with endometriosis already <a href="https://www.endometriosis-uk.org/sites/endometriosis-uk.org/files/files/Endometriosis%20APPG%20Report%20Oct%202020.pdf">wait eight years</a> on average for the right diagnosis, this could make it even more difficult for these women to access care moving forward.</p>
<p>This is why it will be important to begin <a href="https://www.endometriosis-uk.org/sites/endometriosis-uk.org/files/files/Endometriosis%20APPG%20Report%20Oct%202020.pdf">prioritising gynaecological services</a> and treat them with the same level of urgency as other services, such as <a href="https://nhswaitlist.lcp.uk.com">cancer or rheumatology services</a>. To start, it is important to raise general awareness of the condition and its symptoms, and provide education to women on the disease and how to describe it. In combination with community services, such as your GP, this will ensure that women can still get support even while they wait for specialist care.</p>
<p>It will be some time before waiting times for gynaecological services return to normal. But if you’re one of the many women with endometriosis waiting for treatment or a diagnosis, there are some things you can do to prepare for your next appointment. </p>
<p>For example, tracking and recording your symptoms may be useful when visiting a GP so that you can illustrate what type of pain you’re experiencing and how often. This may aid the <a href="https://www.frontiersin.org/articles/10.3389/fgwh.2021.764693/full#h4">communication of your pain</a>, so your GP can better understand your symptoms and <a href="https://www.sciencedirect.com/science/article/abs/pii/S0301211516308247">how best to treat them</a> while you wait for specialist care.</p>
<p>If you or someone you know is having a difficult time managing the condition, Endometriosis UK also offers support through a <a href="https://www.endometriosis-uk.org/helpline">volunteer-run helpline</a>, led by people who know what you’re going through.</p><img src="https://counter.theconversation.com/content/181803/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Danielle Perro receives funding from the Canadian Institute of Health Research Doctoral Foreign Study Award. </span></em></p><p class="fine-print"><em><span>Christian Becker receives funding from Bayer Healthcare, MRC, ERC. He was the chair of the guideline development group of the recentlty published Endometriosis Guideline by the European Society of Human Reproduction and Embryology (ESHRE).</span></em></p>Women with endometriosis already wait up to eight years for a diagnosis in the UK. Post-pandemic delays could make this even worse.Danielle Perro, DPhil Researcher, Nuffield Department of Women's and Reproductive Health, University of OxfordChristian Becker, Associate Professor, Nuffield Department of Obstetrics and Gynaecology,, University of OxfordLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1795002022-03-23T16:27:49Z2022-03-23T16:27:49ZPeople with endometriosis and PCOS wait years for a diagnosis – attitudes to women’s pain may be to blame<figure><img src="https://images.theconversation.com/files/453829/original/file-20220323-23-19qsxu0.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5176%2C3453&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Many women are told not to complain about pain.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/sad-unhappy-woman-suffering-pms-menstruation-1357975841">goffkein.pro/ Shutterstock</a></span></figcaption></figure><p>Former Miss Ireland, Chelsea Farrell, <a href="https://www.rsvplive.ie/life/former-miss-ireland-chelsea-farrell-26463906">recently shared the story</a> of how she ended up in the emergency room in severe pain with a twisted ovarian cyst. </p>
<p>After over two-and-a-half years of symptoms, Farrell found out she had endometriosis, polycystic ovary syndrome (PCOS) and an ovarian cyst. She had suffered pain, irregular periods, bloating and pain during sex, but thought this was normal. </p>
<p>Farrell’s story isn’t unique. Many women face difficulties getting diagnoses, care and treatment for such conditions – with some women even reportedly <a href="https://www.bbc.co.uk/news/av/uk-england-tees-60754629">waiting up to 12 years</a> for help. </p>
<p>There are many <a href="https://theconversation.com/endometriosis-three-reasons-care-still-hasnt-improved-157457">complex reasons</a> behind why women with these conditions wait so long for proper help and treatment. But part of it comes down to how women’s pain is often normalised and dismissed in <a href="https://journals.sagepub.com/doi/abs/10.1111/j.1748-720X.2001.tb00037.x">healthcare settings</a> – and <a href="https://www.jpain.org/article/S1526-5900(21)00035-3/fulltext">even society</a> more widely. </p>
<hr>
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<img alt="Quarter life, a series by The Conversation" src="https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p><em>Working to make a difference in the world but struggling to save for a home. Trying to live sustainably while dealing with mental health issues. For those of us in our twenties and thirties, these are the kinds of problems we deal with every day. <strong><a href="https://theconversation.com/uk/topics/quarter-life-117947?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">This article is part of Quarter Life</a></strong>, a series that explores those issues and comes up with solutions.</em></p>
<p><em>More articles:</em></p>
<p><em><a href="https://theconversation.com/news-of-war-can-impact-your-mental-health-heres-how-to-cope-178734?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">News of war can impact your mental health — here’s how to cope</a></em></p>
<p><em><a href="https://theconversation.com/news-of-war-can-impact-your-mental-health-heres-how-to-cope-178734?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">Body image issues affect close to 40% of men – but many don’t get the support they need</a></em></p>
<p><em><a href="https://theconversation.com/would-you-bring-your-dog-to-a-shop-why-retailers-should-be-more-pet-friendly-178112?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">Would you bring your dog to a shop? Why retailers should be more pet-friendly</a></em></p>
<hr>
<p>In 2020, an <a href="https://www.oxfordmail.co.uk/news/18899456.oxford-school-tells-girls-attend-period/">Oxford school</a> caused controversy after suggesting girls should not miss school because of period pain. It reportedly stated: “Learning to deal with a monthly inconvenience is all part of being a woman.” </p>
<p>Not only does this show a lack of understanding of how debilitating menstrual pain can be, but also how girls are taught early on to endure pain rather than to <a href="https://pubmed.ncbi.nlm.nih.gov/33548448/">seek help or medical advice</a>. </p>
<p>This could also mean girls living with possible signs of endometriosis or PCOS won’t seek the help that they need. In fact, many women with PCOS or endometriosis report they felt expected not to to complain and “<a href="https://www.taylorfrancis.com/chapters/edit/10.4324/9781351035620-9/women-experience-endometriosis-elaine-denny-annalise-weckesser">get on with it</a>”, and to accept that “it’s a woman’s lot to suffer.”</p>
<p>This attitude means that women are often <a href="https://blogs.bmj.com/bmj/2021/05/13/placing-womens-voices-at-the-centre-of-their-care/">not involved in their own care</a> and that their complaints are often dismissed as “women’s problems”. This “<a href="https://www.theguardian.com/society/2020/jul/08/denial-of-womens-concerns-contributed-to-medical-scandals-says-inquiry">arrogant culture</a>” of not taking women’s concerns seriously has even led to decades of medical scandals, avoidable patient harm, and needless suffering.</p>
<h2>Unnecessary wait</h2>
<p>For the last decade, the average wait for an endometriosis diagnosis in the UK is <a href="https://www.endometriosis-uk.org/sites/endometriosis-uk.org/files/files/Endometriosis%20APPG%20Report%20Oct%202020.pdf">eight years</a>. Patients often have up to ten doctor visits before being diagnosed. </p>
<p>For <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6283441/">PCOS</a>, it can often take more than two years and appointments with around three doctors for a diagnosis. Both endometriosis and PCOS are complex conditions with symptoms that may vary widely and also resemble other conditions. So, the <a href="https://bjgp.org/content/71/710/e668#sec-7">diagnostic process is also complex</a>, which explains to some extent why diagnosis is slow. </p>
<p>But complexity around diagnosis is not just about symptoms. The UK government’s recent <a href="https://www.gov.uk/government/consultations/womens-health-strategy-call-for-evidence/outcome/results-of-the-womens-health-lets-talk-about-it-survey">Women’s Health Survey</a> captured how women continue to be dismissed and ignored when seeking care. It can be difficult for them to <a href="https://pubmed.ncbi.nlm.nih.gov/30782020/">put their pain into words</a> and they report not always being believed. </p>
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<img alt="Young woman sitting on a hospital bed waits alone in an examination room." src="https://images.theconversation.com/files/453830/original/file-20220323-23-s7x2p7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/453830/original/file-20220323-23-s7x2p7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/453830/original/file-20220323-23-s7x2p7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/453830/original/file-20220323-23-s7x2p7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/453830/original/file-20220323-23-s7x2p7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/453830/original/file-20220323-23-s7x2p7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/453830/original/file-20220323-23-s7x2p7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Many women wait years for a diagnosis.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/waiting-patient-woman-medical-examination-by-1284262312">Roman Kosolapov/ Shutterstock</a></span>
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<p>Having their pain dismissed leads many women on a <a href="https://journals.sagepub.com/doi/10.1177/1049732309338725">quest for “credibility”</a> in the hopes of being believed that symptoms are not just “<a href="https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1365-2702.2005.01231.x?casa_token=piHGCQ8OUigAAAAA:rPAJhVl25OH6050jAoTRGWHYUCtMdLoHkTpemFZugUaK0aJte1Z1cGWOmEucnOGb9Q0lxQJETjE5baBH">in their head</a>”. But when your <a href="https://www.sciencedirect.com/science/article/abs/pii/S0738399121006431?casa_token=INfsTASb3G0AAAAA:5U4n-hULqmLm2x7xhoG886fdNa7yKhkwmM8xu6pDIK5HKuRPlWECij_WPnaeED8epeU5hST3d8I">experiences aren’t believed</a> by healthcare professionals, it can lead to lower self esteem and even depression. </p>
<h2>Gender health gap</h2>
<p>The struggles that many women experience when trying to receive a diagnosis for these types of conditions is part of a larger problem when it comes to women’s health. Historically, women have experienced inequality in the kind of healthcare and treatment they have received – which is known as the <a href="https://lordslibrary.parliament.uk/womens-health-outcomes-is-there-a-gender-gap">gender health gap</a>. </p>
<p>The gender health gap may explain why women are more likely to suffer <a href="https://pubmed.ncbi.nlm.nih.gov/30082406/">poorer outcomes</a> when treated by male doctors. It may also be why women are more likely to <a href="https://www.bhf.org.uk/what-we-do/news-from-the-bhf/news-archive/2019/september/heart-attack-gender-gap-is-costing-womens-lives">die from heart attacks</a>, as their symptoms can be different from men’s, whose symptoms still dominate medical textbooks and messaging around first aid. </p>
<p>Women’s pain is <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=383803">treated less aggressively</a> than men’s even when they rate it more severely, it lasts longer or occurs more often. </p>
<p>The gender health gap is even wider for <a href="https://www.hsph.harvard.edu/news/hsph-in-the-news/discrimination-black-womens-health/">black women</a> living in the US and UK. Black women are <a href="https://pubmed.ncbi.nlm.nih.gov/30908874/">less likely</a> to be diagnosed with endometriosis than white women. They’re also more likely to <a href="https://www.nytimes.com/2020/04/15/parenting/fertility/black-women-uterine-fibroids.html">develop uterine fibroids</a> and are significantly more likely to have <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3787340/">debilitating symptoms</a> because of them. </p>
<p>Black women may also be more <a href="https://rsphealth.org/pcos/">disproportionately affected by PCOS</a>. Though the reasons for this aren’t fully understood, it might partly be due to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6822100/">poorer access</a> to healthcare.</p>
<p>While problems with women’s health are increasingly being recognised, repeated calls in the past to raise awareness and education for <a href="https://www.endometriosis-uk.org/sites/endometriosis-uk.org/files/files/Endometriosis%20APPG%20Report%20Oct%202020.pdf">girls, women, and healthcare professionals</a> haven’t led to much-needed change. It’s essential that better, <a href="https://bjgp.org/content/71/710/e668#sec-7">evidence-based resources</a> are developed for both women and health professionals to ensure that every woman – no matter her health needs or experiences – can receive the right care. </p>
<p>But it’s simplistic to assume that the difficulties women face in accessing equitable healthcare and the right diagnosis will be solved by more information alone. </p>
<p>We must also address the <a href="https://theconversation.com/endometriosis-three-reasons-care-still-hasnt-improved-157457">larger societal issues</a> of stigmatising and de-prioritising women’s health, the inadequate funding for women’s health research and the implicit gender and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8004354/">racial biases</a> that underpin current health inequalities. </p>
<p>It’s unlikely that significant changes in the way women’s healthcare is delivered will happen anytime soon. So for now, it will be important that women continue to advocate for their own health. </p>
<p>If you suspect you may have endometriosis or PCOS, continue to seek help. Consider <a href="https://www.endometriosis-uk.org/sites/endometriosis-uk.org/files/files/Information/pain-symptoms-diary.pdf">keeping track</a> of your pain and symptoms so you can discuss them with your GP. Remember, pain is not something you have to put up with.</p><img src="https://counter.theconversation.com/content/179500/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anne-Marie Boylan has received funding from the National Institute of Health Research (NIHR). </span></em></p><p class="fine-print"><em><span>Annalise Weckesser has received funding from NIHR and ESRC previously. </span></em></p><p class="fine-print"><em><span>Sharon Dixon work on endometriosis in primary care was funded by the National Institute for Health Research (NIHR) School for Primary Care Research (project number: 403). </span></em></p>The “gender health gap” may be at the root of this problem.Anne-Marie Boylan, Departmental Lecturer & Senior Research Fellow, University of OxfordAnnalise Weckesser, Senior Research Fellow, Medical Anthropology, Birmingham City UniversitySharon Dixon, Researcher, Primary Care Health Sciences, University of OxfordLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1746492022-01-17T16:30:50Z2022-01-17T16:30:50ZHow going from care to prison compounds women’s trauma – new research<figure><img src="https://images.theconversation.com/files/441307/original/file-20220118-17-lgee9s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Of the women in custody, those who have been through the care system are over-represented. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/silhouette-womans-head-waving-hair-back-563555992">MikeDotta | Shutterstock</a></span></figcaption></figure><p>In the year to June 2021, for every 1,000 women in custody in England and Wales, 3,808 incidents of self-harm were recorded. This represented a shocking increase of <a href="https://www.gov.uk/government/statistics/safety-in-custody-quarterly-update-to-june-2021/safety-in-custody-statistics-england-and-wales-deaths-in-prison-custody-to-september-2021-assaults-and-self-harm-to-june-2021">16%</a> on the previous year. Between March 2007 and March 2018, 37 women in prison <a href="https://www.inquest.org.uk/Handlers/Download.ashx?IDMF=8d39dc1d-02f7-48eb-b9ac-2c063d01656a">took their own lives</a>. </p>
<p>Evidence suggests that the link between self-harm and suicide is <a href="https://webarchive.nationalarchives.gov.uk/ukgwa/20130206102659/http:/www.justice.gov.uk/publications/docs/corston-report-march-2007.pdf">stronger in prisons</a> than in the wider community. For a <a href="https://journals.sagepub.com/doi/10.1177/17488958211067914">recent study</a> we conducted interviews with 37 women in three closed prisons in England between September 2019 and February 2020. A key aim of our research was to amplify women’s voices. Self-harm was not an issue we had set out to explore in this study, but it was a topic that many nevertheless chose to share. </p>
<p>Our findings show that having prior experience of living in care can provide crucial context for understanding why some women in prison might self-harm. All the women we spoke with had experience of the <a href="https://theconversation.com/new-laws-in-england-will-leave-16-year-olds-living-alone-167756">care system</a> before going to prison. Self-harm was raised as a key issue by some.</p>
<h2>Unmet needs</h2>
<p>Women who have been through the care system are over-represented in prisons in England. While there are challenges in obtaining accurate data, estimates suggest that <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/278837/prisoners-childhood-family-backgrounds.pdf">31% of female prisoners</a> (compared to 24% of imprisoned men) spent time in the care of the state as children. </p>
<p>This is, of course, <a href="https://theconversation.com/why-have-so-many-people-in-prison-spent-time-in-care-as-children-66941">not inevitable</a>. Many care leavers go on to do very well when appropriately supported. But a significant minority do come into contact with the justice system, with challenging behaviour such as minor damage to property still <a href="http://www.prisonreformtrust.org.uk/Portals/0/Documents/In%20care%20out%20of%20trouble%20summary.pdf">more likely to be criminalised</a> in some care settings than for those living at home with their birth families. This is often compounded by the stigma attached to being in care. Negative attitudes assume some care leavers will inevitably be troublesome.</p>
<p>Many of the women we interviewed described backgrounds of abuse and neglect and being taken into care for their welfare and protection. As one interviewee, Mandy, explained:</p>
<blockquote>
<p>I was a traumatic child … very, very out of control … I didn’t know how to ask for help. Because in the care system I was never shown all that. </p>
</blockquote>
<p>For some, self-harm became a way of communicating their trauma. Several described harming themselves as a way of alleviating psychological pain. In the most severe cases, for those women who tried to take their own lives, it became an attempt to end that pain. </p>
<figure class="align-center ">
<img alt="A woman with a clipboard holds another woman's hands in a therapy setting." src="https://images.theconversation.com/files/441050/original/file-20220117-19-1v0so5f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/441050/original/file-20220117-19-1v0so5f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/441050/original/file-20220117-19-1v0so5f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/441050/original/file-20220117-19-1v0so5f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/441050/original/file-20220117-19-1v0so5f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/441050/original/file-20220117-19-1v0so5f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/441050/original/file-20220117-19-1v0so5f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Women describe having difficulty accessing mental health support and medication when arriving in prison.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-female-doctor-hold-woman-patient-1714751662">fizkes | Shutterstock</a></span>
</figcaption>
</figure>
<h2>Systemic failure</h2>
<p>There has been a tendency for research to focus on <a href="https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(20)30190-5/fulltext">the personal factors</a> that might lead an individual to self-harm. Research on the sociology of punishment, however, has highlighted how self-injury may be <a href="https://journals.sagepub.com/doi/10.1177/1362480615595283">linked</a> to the painful experiences of imprisonment for some women, such as separation from loved ones.</p>
<p>Our own research draws attention to what is lacking in the systems designed to support these women. Women described delays in accessing medication on entry to prison and in obtaining mental health appointments, among other challenges. Not feeling listened to in care was a common theme often repeated in prison. As Leanne put it:</p>
<blockquote>
<p>There’s a lot of self-harm in this prison, a lot. Because they don’t feel heard … they don’t get dealt with in the right manner. They just get locked away and … labelled.</p>
</blockquote>
<p>For some, experiences of the prison system echoed experiences the women described from their time in care, which was often characterised by instability and a lack of support. Their mental health needs went unmet – they were frequently moved from placement to placement. </p>
<p>For women who were previously in the care of the state as children, access to mental health support is crucial, as is making sure that those who leave care are <a href="http://wp.lancs.ac.uk/care-custody/files/2019/10/CareCustodyLiteratureReview.pdf">not abandoned</a>. More broadly, our findings raise serious questions about how we, as a society, use imprisonment as a punitive measure for these women. </p>
<p>While there are ongoing efforts to identify and improve the <a href="https://hmppsintranet.org.uk/uploads/6.6018_HMPPS_People%20with%20care%20experience%20strategy_WEB.pdf">support</a> available to those who have gone from care to prison, research also shows the <a href="https://theconversation.com/why-rehabilitation-not-harsher-prison-sentences-makes-economic-sense-132213">potential of community sentences</a>, such as deferred prosecution schemes, to be credible, cost-effective alternatives to custody that avoid the trauma of imprisonment. Even better, however, is to ensure that children in care receive all the support they need. This would help to <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/765082/The_national_protocol_on_reducing_unnecessary_criminalisation_of_looked-after_children_and_care_.pdf">prevent</a> those who have been in care from being unnecessarily criminalised in the first place.</p>
<p><em>All names have been changed to protect the identity of the participants. If you are affected by any of the issues in this piece, please consider talking to someone. The Samaritans helpline - 116 123 - is available 24 hours a day.</em></p><img src="https://counter.theconversation.com/content/174649/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The study on which this piece is based was carried out with Dr Katie Hunter (Lancaster University), Dr Julie Shaw (Liverpool John Moores University) and Dr Jo Staines (University of Bristol). This research was funded by the Nuffield Foundation, but the views expressed are those of the authors and not necessarily the Foundation. Visit <a href="http://www.nuffieldfoundation.org">www.nuffieldfoundation.org</a></span></em></p>Care leavers are over-represented in the justice system. Rising rates of self-harm show an urgent need for greater mental health support.Claire Fitzpatrick, Senior Lecturer in Criminology, Lancaster UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1574572021-03-25T13:49:07Z2021-03-25T13:49:07ZEndometriosis: three reasons care still hasn’t improved<figure><img src="https://images.theconversation.com/files/391694/original/file-20210325-13-1k2yxob.jpg?ixlib=rb-1.1.0&rect=0%2C4%2C3330%2C1992&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Women wait an average of eight years for diagnosis.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/woman-on-consultation-gynecologist-experiencing-pain-1789709066">Cadmium_Red/ Shutterstock</a></span></figcaption></figure><p>Around <a href="https://www.endometriosis-uk.org/endometriosis-facts-and-figures">1.5 million women</a> in the UK suffer from endometriosis, a painful and debilitating condition that can affect every aspect of a person’s life. The condition causes tissue similar to the lining of the womb to grow elsewhere – including in the ovaries and fallopian tubes – and can result in severe pelvic or period pain.</p>
<p>Treatments for endometriosis include painkillers, hormone medicines and contraceptives, and surgery (laparoscopy and hysterectomy). But some women find these ineffective and <a href="https://www.tandfonline.com/doi/abs/10.1080/01674820400002279">abandon medical treatment</a> or seek <a href="https://www.sciencedirect.com/science/article/abs/pii/S1353611702001385">alternative therapies</a>. In the UK, women also wait an average of <a href="https://pubmed.ncbi.nlm.nih.gov/31328629/">eight years</a> for a diagnosis.</p>
<p>Although a recent small trial of a <a href="https://pilotfeasibilitystudies.biomedcentral.com/articles/10.1186/s40814-021-00797-0">potential new endometriosis treatment</a> has left researchers <a href="https://www.bbc.co.uk/news/health-56245521">feeling hopeful</a>, there is still no cure for this condition – and treatments have progressed little since the condition was first recognised in the 1920s. Here are three reasons endometriosis care has been slow to improve.</p>
<h2>1. Endometriosis is not a priority condition</h2>
<p>Investment in research on endometriosis, and <a href="https://www.ukcrc.org/wp-content/uploads/2015/08/UKCRCHealthResearchAnalysis2014-WEB.pdf">women’s reproductive health generally</a>, remains low compared with conditions such as diabetes, which are <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)31344-2/fulltext">similarly prevalent</a> but affect both men and women. </p>
<p>An <a href="https://www.endometriosis-uk.org/sites/endometriosis-uk.org/files/files/Endometriosis%20APPG%20Report%20Oct%202020.pdf">All Party Parliamentary Group inquiry</a> into endometriosis care found that there have been no significant treatment breakthroughs because endometriosis research hasn’t been a priority. Worse, it means we still don’t fully understand what causes the disease, making it difficult to develop a cure. </p>
<p>Women with symptoms must first see a GP to receive a referral to specialist care for diagnosis and surgical treatment. But <a href="https://www.endometriosis-uk.org/sites/endometriosis-uk.org/files/files/Endometriosis%20APPG%20Report%20Oct%202020.pdf">more than half of women</a> have to visit a GP more than ten times before they are referred to a specialist. The UK’s National Institute for Health and Care Excellence <a href="https://www.bmj.com/content/358/bmj.j4186.full">urge GPs</a> to better prioritise endometriosis for further investigation to quicken diagnoses. </p>
<h2>2. Endometriosis is poorly understood</h2>
<p>Few people know what endometriosis is. A recent study I co-authored shows only <a href="https://pubmed.ncbi.nlm.nih.gov/33548448/">8% of teenage girls</a> in the UK know about endometriosis. By comparison, <a href="https://pubmed.ncbi.nlm.nih.gov/12609335/">39% know about Parkinson’s disease</a>, even though Parkinson’s affects <a href="https://www.parkinsons.org.uk/sites/default/files/2018-01/CS2960%20Incidence%20and%20prevalence%20report%20branding%20summary%20report.pdf">about a tenth</a> the number of people as endometriosis. </p>
<p>Our study also revealed <a href="https://pubmed.ncbi.nlm.nih.gov/33548448/">27% of teenage girls</a> were unsure if their period was “normal”. This is important, as many adults with endometriosis <a href="https://pubmed.ncbi.nlm.nih.gov/18367178/">didn’t seek medical help</a> when they were younger because they thought their symptoms – like excessive period pain or heavy menstrual bleeding – were typical. It’s <a href="https://static1.squarespace.com/static/5757c9a92eeb8124fc5b9077/t/5d41adfc49a80d0001f41b82/1564585493903/Informed+Choice+Report+Final.pdf">argued</a> that if young women know what typical periods look like, they’ll be better able to identify signs of endometriosis and seek care earlier. This may also quicken their diagnosis.</p>
<p>Research also shows <a href="https://pubmed.ncbi.nlm.nih.gov/19699572/">stigma around discussing menstruation</a> prevents some women from talking about endometriosis symptoms, even with doctors. Further, stigmatisation of menstruation in society as a whole means researchers and doctors are <a href="https://static1.squarespace.com/static/5757c9a92eeb8124fc5b9077/t/5d41adfc49a80d0001f41b82/1564585493903/Informed+Choice+Report+Final.pdf">less interested</a> in pursuing endometriosis as a speciality area, hampering strides in improving care. </p>
<p>Endometriosis is also often mistakenly thought of <a href="https://rowman.com/ISBN/9781793601889/Healers-and-Patients-Talk-Narratives-of-a-Chronic-Gynecological-Disease">as solely a menstrual health condition</a>. There are non-menstruation related symptoms that even some health professionals are <a href="https://www.endometriosis-uk.org/sites/endometriosis-uk.org/files/files/Endometriosis%20APPG%20Report%20Oct%202020.pdf">not adequately familiar</a> with, including painful urination or bowel movements, non-period related pelvic pain, painful intercourse and fatigue. This means clinicians often <a href="https://www.endometriosis-uk.org/sites/endometriosis-uk.org/files/files/Endometriosis%20APPG%20Report%20Oct%202020.pdf">misdiagnose</a> endometriosis.</p>
<figure class="align-center ">
<img alt="Woman sitting in doctor's office speaking with doctor." src="https://images.theconversation.com/files/391696/original/file-20210325-21-jwei21.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/391696/original/file-20210325-21-jwei21.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/391696/original/file-20210325-21-jwei21.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/391696/original/file-20210325-21-jwei21.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/391696/original/file-20210325-21-jwei21.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/391696/original/file-20210325-21-jwei21.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/391696/original/file-20210325-21-jwei21.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Symptoms may mean endometriosis is not be properly diagnosed.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/healthcare-medical-concept-doctor-psychiatrist-consulting-1305333748">smolaw/ Shutterstock</a></span>
</figcaption>
</figure>
<p>Endometriosis also does not conform neatly to biomedical <a href="https://blogs.bmj.com/bmj/2020/08/11/reclassifying-endometriosis-as-a-syndrome-would-benefit-patient-care/">models of disease</a>, meaning disease extent doesn’t always equate to symptom severity. Some women with endometriosis may have few symptoms, but have extensive “endo” (tissue), whereas others may experience severe pain, but have a small amount of endo tissue. In such cases, some <a href="https://insights.ovid.com/diversity-health-social-care/dhsc/2004/01/010/one-unlucky-ones-delay-diagnosis-endometriosis/7/01212971">women report</a> they’ve been told by doctors that their symptoms cannot be “that bad”, with their accounts seen as less credible than what is detected by currently available measures. This means endometriosis can be <a href="https://blogs.bmj.com/bmj/2020/08/11/reclassifying-endometriosis-as-a-syndrome-would-benefit-patient-care/">misunderstood by health professionals</a>.</p>
<h2>3. Sufferers’ accounts have been dismissed for decades</h2>
<p>In 2001, a colleague of mine interviewed women who suffered from endometriosis. She found that health professionals <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2648.2004.03055.x">trivialised endometriosis symptoms</a> as “typical period pain”. </p>
<p>Nearly two decades on, our research found women still feel <a href="https://pilotfeasibilitystudies.biomedcentral.com/articles/10.1186/s40814-018-0358-5">disbelieved and desperate</a> for relief from their symptoms. <a href="https://discoversociety.org/2020/06/03/its-a-challenge-doctors-perspectives-on-diagnosing-endometriosis-and-improving-care/">GPs confirm</a> women come to them “ready for battle”, expecting not to be believed or made to feel that “it’s all in their head”. </p>
<p>Even the previously mentioned <a href="https://www.endometriosis-uk.org/sites/endometriosis-uk.org/files/files/Endometriosis%20APPG%20Report%20Oct%202020.pd">endometriosis inquiry</a> <a href="https://www.theguardian.com/commentisfree/2020/oct/22/endometriosis-women-pain-diagnosis-report-mps">revealed nothing new</a> about the dismissal of endometriosis sufferers’ accounts. This was a missed opportunity to examine how to tackle this problem. It also didn’t adequately include the experiences of people of colour and the LGBTQ+ community. Both communities that, based on existing <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6761838/">health inequalities evidence</a>, are more likely to have their <a href="https://www.health.org.uk/news-and-comment/news/health-foundation-statement-on-racial-inequalities-in-health">symptoms poorly treated</a>. In healthcare, <a href="https://journals.sagepub.com/doi/abs/10.1111/j.1748-720X.2001.tb00037.x">gender biases</a> mean women’s pain isn’t investigated as seriously as men’s. A recent <a href="https://academic.oup.com/jpepsy/article/44/4/403/5273626?login=true">Yale study</a> even showed girls’ pain is taken less seriously than boys’. </p>
<p>The struggle to have endometriosis accounts believed is part of a larger, systematic dismissal of <a href="https://oxford.universitypressscholarship.com/view/10.1093/0195161920.001.0001/acprof-9780195161922">women’s experiences of their bodies</a>. Recent discussions about women’s experiences of <a href="https://theconversation.com/lockdown-violence-and-understanding-womens-anger-157180">sexual harrassment</a>, or Meghan Markle’s account of <a href="https://theconversation.com/meghan-markle-the-uk-press-and-the-problem-of-diversity-156992">racial bias in the media</a> are both examples of women needing to fight to have their story believed. And when health professionals don’t take women’s accounts seriously, it may mean diagnosis delays and ineffective treatments.</p>
<p>Taking endometriosis sufferers’ accounts seriously is the linchpin to improving care. For the long-overdue improvements to endometriosis treatment, diagnosis and care to happen, we need to believe and prioritise the words of endometriosis sufferers. Greater awareness and understanding of the condition will help.</p><img src="https://counter.theconversation.com/content/157457/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Annalise Weckesser does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Taking sufferers’ accounts seriously is the linchpin to improvement.Annalise Weckesser, Senior Research Fellow, Medical Anthropology, Birmingham City UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/494282015-12-09T22:32:31Z2015-12-09T22:32:31ZGenders experience pain differently, and women have it more<figure><img src="https://images.theconversation.com/files/102792/original/image-20151123-18233-w53w1o.png?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">More women suffer pain from almost all afflictions, and we still don't understand why.</span> <span class="attribution"><span class="source">from www.shutterstock.com.au</span></span></figcaption></figure><p><a href="http://www.ncbi.nlm.nih.gov/pubmed/11166468">More women than men</a> suffer from chronic pain, described as pain that persists for more than six months. In addition, much of this pain <a href="http://www.iasp-pain.org/GlobalYear/PaininWomen">remains undiagnosed or untreated</a>.</p>
<p>As well as the pain associated with menstruation or the bearing of children, waiting rooms of pain physicians, rheumatologists and gastroenterologists show clear majorities of women. </p>
<p><a href="http://www.ncbi.nlm.nih.gov/pubmed/17964077">Research has found</a> the only pain conditions more common in men are the relatively infrequent cluster headaches (where strong pain occurs on one side of the head), nerve pain after shingles, ankylosing spondylitis (a form of spinal arthritis) and migraine without perceptual disturbances of light and smell (called “aura”).</p>
<p>Everything else – from pelvic pain, irritable bowel syndrome, all other headaches, multiple sclerosis, rheumatoid arthritis, jaw pain, bladder pain syndrome, fibromyalgia, chronic regional pain syndrome to odontalgia (painful teeth) – is more common in women.</p>
<p>Men and women also describe pain differently. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19586722">Research found</a> women tended to use more descriptive, graphic language with a focus on sensory symptoms. Men were more likely to express anger or swear, but recalled the event more objectively. </p>
<p>Male subjects’ written responses were shorter and less detailed, with potential influences being gender role expectations of pain response, a male reticence to report painful sensations and feelings of embarrassment when reporting a pain experience. </p>
<h2>History of thinking about pain</h2>
<p>We understand pain in others best when we have real or imagined shared experience. Pain in women is frequently both unable to be visualised (unlike lacerations or other visible injuries) and outside the experience of their health professional. </p>
<p>How to view the female patient with pain that can’t be seen is a problem the Ancient Greeks pondered as early as <a href="http://www.cambridge.org/au/academic/subjects/classical-studies/ancient-history/women-and-society-greek-and-roman-egypt-sourcebook">400 BC</a>. Faced with a complex range of suffering and complaints in women, Ancient Greek physicians came up with a novel explanation: the “wandering womb”. The womb was believed to move upward in a woman’s body whenever it became hot and dry, searching for cool moist places, and causing stress and damage to her physical and mental well-being.</p>
<p>Hippocrates (460-370 BC) used the term “hysteria”, which derives from the Greek word “hysteros” for “womb”, to describe a wide variety of female emotional and physical conditions. By inference this labelled women in pain as weak, inferior or irrational. Parallel to their inferior social position in Ancient Greece, Aristotle (384-322) used the concept of hysteria in his book, <a href="http://oll.libertyfund.org/titles/903">The Nicomachean Ethics</a>, as proof that women were unsuitable for public office.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/104176/original/image-20151203-22470-jqzwiz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/104176/original/image-20151203-22470-jqzwiz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/104176/original/image-20151203-22470-jqzwiz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/104176/original/image-20151203-22470-jqzwiz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/104176/original/image-20151203-22470-jqzwiz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/104176/original/image-20151203-22470-jqzwiz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/104176/original/image-20151203-22470-jqzwiz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/104176/original/image-20151203-22470-jqzwiz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">There’s a common belief that women have a higher pain threshold so they can give birth, but actually men’s pain threshold is higher.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
</figcaption>
</figure>
<p>While such beliefs seem far-fetched today, the diagnosis of “hysteria” continued to be commonly used in European medical practice to describe a wide variety of symptoms in women for the next 2,000 years. Only in 1980 was it removed from the DSM III Manual of Psychiatric Disorders.</p>
<p>Unlike women, historical accounts of men’s pain have been influenced by their ability to withstand injuries incurred in warfare. As English poet William Cowper (1792) <a href="http://www.amazon.com/The-Story-Pain-Prayer-Painkillers/dp/0199689423">noted</a>, incitements including “renown and glory” helped men disregard pain on the battlefield.</p>
<h2>Research in pain</h2>
<p>In 1977, with concern about the risk that new drugs might have on an undiagnosed pregnancy, the US Food and Drug Administration recommended that all women who were capable of becoming pregnant be excluded from drug trials. The presumption was that pain research in men would be applicable to both genders. While well intentioned, the consequence of this decision has been that the majority of <a href="http://www.cwhn.ca/en/node/43287">pain research</a> has been undertaken in male humans or male rodents. </p>
<p>This decision has since been reversed, and research into pain differences between the sexes has dramatically increased. While results have at times been conflicting, what we are learning is that females consistently show <a href="http://www.ncbi.nlm.nih.gov/pubmed/21094890">lower pain thresholds</a> and increased pain following a painful stimulus than males. This doesn’t mean women are weaker than men or their pain isn’t real, but they feel pain more intensely than men. </p>
<p>Pains specifically associated with women, such as <a href="http://www.ncbi.nlm.nih.gov/pubmed/26262827">menstrual pain</a>, may predispose women to feeling pain more acutely in other areas. <a href="http://www.ncbi.nlm.nih.gov/pubmed/24731947">Women’s brains</a> produce less endorphin (which inhibits pain) following a pain stimulus than men. Yet when morphine is given to treat pain, it generally works equally well in either gender. </p>
<p>Clearly there is still a lot to learn about gender and pain. Newer thinking suggests that pain in men and women may even occur through entirely different mechanisms and pain pathways. </p>
<p>For example, microglia are cells from the immune system involved in chronic pain. <a href="http://www.ncbi.nlm.nih.gov/pubmed/26120961">Research</a> in mice has shown that drugs that prevent activation of microglia are effective in reducing pain in male, but not female, mice. </p>
<p>So, the observed differences in ability to withstand acute pain on a battlefield (traditionally associated with males) and ability to withstand the pain of chronic disease (more commonly associated with females) may prove to have a physiological basis.</p>
<p>Every one of our cells knows whether we are male or female and responds accordingly. That there are differences between male and female pain should not be surprising.</p>
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<p><em>This article is part of a series focusing on Pain. Read other articles in the series <a href="https://theconversation.com/au/topics/pain-series">here</a>.</em></p><img src="https://counter.theconversation.com/content/49428/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Susan Evans receives research funding from the Anaesthesia and Pain Medicine Foundation. She receives royalties from purchase of her book Endometriosis and Pelvic Pain, and has received payment on behalf of the Pelvic Pain Foundation of Australia for presentations on Pelvic Pain from both Bayer and Pfizer.</span></em></p>More women than men suffer from chronic pain, that is, pain that persists for more than six months. In addition, much of this pain remains undiagnosed or untreated.Susan Evans, Honorary Lecturer, Gynaecologist, Pain Medicine Physician, Laparoscopic Surgeon, University of AdelaideLicensed as Creative Commons – attribution, no derivatives.