How Doctors Discount Women’s Pain

“In one portrait Shalon wore a vibrant smile and the crisp uniform of the Commissioned Corps of the U.S. Public Health Service, where she had been a lieutenant commander.… At 36, Shalon had been part of their elite ranks — an epidemiologist at the Centers for Disease Control and Prevention, the preeminent public health institution in the U.S. There she had focused on trying to understand how structural inequality, trauma and violence made people sick.… Then the unthinkable had happened. Three weeks after giving birth, Shalon had collapsed and died.”

In 2017, ProPublica detailed the circumstances leading to the untimely death of Shalon Irving, a black thirty-six-year-old new mother whose postpartum complications were insufficiently addressed by a sociocultural structure that disregards the needs of women. Women’s concerns are often dismissed when they encounter the medical system, especially their expressions of pain. Studies have shown that black patients’ pain is frequently undertreated, and black women face much higher risks of mortality due to medical complications than white women. Alongside the official studies, anecdotal evidence abounds. A 2015 article in the Atlantic detailed the author’s wife being ignored in an emergency room while she suffered from an excruciating—and potentially life-threatening—ovarian condition. Even Buzzfeed has chronicled women’s stories of being told to grin and bear it when, in actuality, they faced serious medical issues.

The seminal 2001 study “The Girl Who Cried Pain: A Bias Against Women in the Treatment of Pain” chronicled the ways in which physical pain in women is regularly overlooked, be it through misdiagnosis or inadequate treatment, and even though it’s been nearly twenty years since the study’s publication, the unequal management of women’s pain in health care settings persists. The majority of chronic pain sufferers are women, but women’s pain is much more likely to be incorrectly categorized as emotional or psychological in nature and therefore undertreated. This is especially the case with autoimmune disorders: 75 percent of those who suffer from them are women, and it often takes years to receive a proper diagnosis.  

So what should we do knowing that the system has this inherent bias? Physicians use a suite of basic lab tests and imaging to do assessments of patients, and developing knowledge around these tests can really help you help yourself.  Serena Williams saved her own life postpartum due to her knowledge of diagnostic technology for her specific condition!

Being an advocate for yourself by knowing and understanding lab test results (especially abnormal results) can help you get the treatment you need and help you evaluate whether you are getting good advice. If you’re experiencing persistent pain, here are some basic tests you might consider investigating:

Diabetes Testing

Test yourself for elevated blood sugar.  A diagnosis of diabetes will have a huge effect on your health and people often live with it for years before getting diagnosed.  The screening test is called the Hemoglobin A1c test.

Micronutrient tests

Deficiencies in vitamin D, vitamin B12, and magnesium have all been linked to various manifestations of pain, including muscle cramps and headaches. Vitamin D levels can be measured with the 25-hydroxy vitamin D test, while the vitamin B12 test and the methylmalonic acid (MMA) test can be used to diagnose B12 deficiency, which can be a symptom of inflammatory digestive tract disorders like celiac disease or Crohn’s. A serum magnesium test can help diagnose a lack of magnesium in the blood.

 

Complete blood count (CBC)

Among other information, this test can provide evidence of anemia (low red blood cell count) and inflammation or infection (high white blood cell count). These may be symptoms of medical conditions associated with pain, including autoimmune disorders and vitamin deficiencies.

Hormonal assays

Of particular interest for women among these wide-ranging tests might be a thyroid panel, which includes TSH (thyroid-stimulating hormone), free T4 (thyroxine), and free T3 or total T3 (triiodothyronine). Women are much more likely than men to develop either overactive thyroids (hyperthyroidism) or underactive thyroids (hypothyroidism), conditions that can cause pain, stiffness, or weakness in the muscles and joints, digestive upset, and swelling or other discomfort around the neck.

Tests for inflammation

Inflammation can be an indicator of digestive issues, heart disease, vasculitis, and autoimmune disorders, among other painful conditions. C-reactive protein (CRP) is produced by the body in response to inflammation, so testing for high levels of CRP in the blood can help diagnose inflammation, as can the erythrocyte sedimentation rate (ESR) test.

Autoimmune testing

An antinuclear antibody (ANA) panel tests the level of ANA in your blood. These are the antibodies that mistakenly attack healthy cells in people with autoimmune disorders like inflammatory bowel disease, rheumatoid arthritis, Crohn’s disease, and lupus, all of which cause pain. If your blood contains a high level of ANA, more specific testing is likely required. For example, a test for rheumatoid factor (RF) antibodies can help identify rheumatoid arthritis.

 

The results

Remember that what constitute healthy test results for you will, to a certain extent, depend on personal factors, like your age, overall health, and body type. Reviewing and understanding your lab results can help build a strong foundation to ensure you’re receiving the best medical care.