Going back to ancient Greece, women’s medical issues have been met with doubt and discrimination, even though chronic pain affects women at higher numbers than men. There is a gender bias in health care, with one study finding that in nearly three-quarters of the cases where a disease afflicts primarily one gender, the funding pattern favors males.
This week, LAist’s public affairs show “AirTalk,” which airs on 89.3 FM, is airing a weeklong series digging into topics relating to women’s health care, a vast and often understudied area.
Dr. Sarah Kilpatrick, maternal fetal medicine specialist and chair of the OB-GYN department at Cedars-Sinai Medical Center, says this knowledge gap leads to significant consequences like delayed diagnoses. Far less federal funding is allocated towards research of diseases that primarily afflict women, like endometriosis and cervical cancer, than diseases that affect men, like prostate cancer, Kilpatrick says — and most of the research that informs direct patient care today is based on male subjects and male cells.
This is in part because there has historically been a reluctance to include women in clinical trials, since it can be harder to account for their physiological state due to hormonal changes like menstruation, menopause, and birth control, according to Kilpatrick. And there is a particular lack of understanding on how diseases and medications affect pregnant women, she says, as researchers are afraid of taking risks with the fetus.
“The fetus takes more precedence over the mother's disease,” Kilpatrick says. “So we're in this conundrum of having a pregnant patient who has an underlying disease like hypertension or heart disease, and having to treat her and having zero research on knowing what medications are safe, what doses they should be on, etcetera.”
Particularly with diseases that are harder to quantify — where diagnoses factor in self-reported symptoms like pain and fatigue — women’s symptoms and experiences are not taken seriously, according to Maya Dusenbery, a journalist and author of the book Doing Harm: The Truth about how Bad Medicine and Lazy Science Leave Women Dismissed, Misdiagnosed, and Sick.
Up to 50 million people in the U.S. are estimated to have autoimmune conditions, which disproportionately impact women, Dusenbery says. But some people have to hop from doctor to doctor for years before they are able to get a diagnosis.
“So many [autoimmune patients] report feeling like their symptoms are really dismissed and underplayed by doctors, often psychologized,” Dusenbery says. “It's really common to hear [that] it's just stress or anxiety or depression.”
The pain associated with endometriosis is often chalked up to menstrual cramps, for example, and doctors tend to normalize many of the symptoms that women report.
“There's this long history in medicine of blaming all of women's unexplained symptoms on hysteria,” Dusenbery says. “We don't use that term anymore. But I think that concept is really alive and well today.”
Chronic fatigue syndrome has been under-researched for decades, Dusenbery says, but when millions of people began experiencing it along with long COVID, it began harder to dismiss the symptoms as psychosomatic.
“We saw a really powerful effort by patient activists to define this as a real emerging phenomenon that we need to study,” Dusenbery says. “So I'm very hopeful and I do think that it was only because patients formed support groups and made their voices heard that we saw that change happen.”
Anushay Hossain, the author of The Pain Gap: How Sexism, Racism, and Healthcare Kill Women, says there is a big difference in how men and women’s pain is perceived.
“One of the most fascinating things about women's pain is that it's Biblical that we're supposed to have this really high threshold for pain, yet when we tell people that we are in pain, we are not believed,” Hossain says.
Women are expected to wait longer in the emergency room through their pain, Hossain says, while men are more likely to be prescribed medications to manage their pain.
“There is a pain gap, but there's also a credibility gap,” she says. “Women are simply not believed about our pain — not believed about our bodies, period.”
Women’s health is often reduced to just the breasts and reproductive organs — a tendency nicknamed "bikini medicine,” Dusenbery says. But women’s physiology is different in other ways too, and their experiences of many conditions can be different from men’s. Kilpatrick says that it will take a concerted effort to achieve this more expansive understanding of women’s bodies.
“If you think how long it takes from research to clinical outcome — years and years and years — we're so far behind in our knowledge gap that we need for women, and how women's health is different, that we just need to be on super-speed to get this moving forward so that we can have the information that we need,” Kilpatrick says.
