In a room at Yale Fertility Clinic, a woman lies on the table, visibly nervous but determined. This procedure is her only chance to have children, and she trusts the professionals standing around her. The physician begins, and she is immediately in pain. Excruciating pain. She cries out, asking for more painkillers, but the physician informs her that she has already received the maximum dosage of medication. She grits her teeth and goes through with it, hoping maybe the drugs will kick in—or if she’s lucky, she’ll pass out. Later, she wakes up in the waiting room, still in excruciating pain. She hears something about how the pain is because they collected so many eggs. She accepts it, trusting that the medical professionals have worked hard to ensure her experience is normal.
Maybe one woman who experiences this pain can be considered an unfortunate but predictable outlier, but she’s not alone. Nearly 100 women were treated at the Yale Fertility Clinic without proper medication in 2020. A nurse with a drug addiction had been switching the fentanyl used for pain relief with saline. It went unnoticed for months, as the women’s pain was dismissed as routine and their complaints categorized as dramatic. When it was eventually discovered, the women were afforded a settlement, but the experience of these women is indicative of a wider trend in the medical system.
In the US medical system, there exists a pain gap: Lower levels of sedation are used in procedures experienced uniquely by women, and women are dismissed when they express pain. Women are forced to endure pain at a higher level than men due to normalized painful female reproductive procedures, a lack of research into women’s bodies, and the cultural attitude of dismissing women as sensitive and dramatic.
Women have come to expect pain in procedures relating to their reproductive health. For example, during c-sections—the most frequently performed major surgery—neuraxial anesthesia is common practice. This includes spinals, epidurals, and other similar methods. While these methods are largely regarded as reliable, pain during c-section occurred in 11.9 to 22.7 percent of patients. It is abhorrent that up to one fifth of women experience pain during c-sections—clearly, another pain relief mechanism should be explored. However, due to a lack of motivation within the medical community, this seems unlikely.
If the medical community wants to address this issue, two major hurdles need to be cleared: Women need to be included in medical research, and the pain they experience needs to be taken seriously. Women have historically been underrepresented in medical research; for example, from 2016 to 2019, only 41.2 percent of clinical trial participants were female. This has contributed to a relative lack of understanding of the female body, and consequently a lack of understanding of how women experience pain. If the medical community refuses to take the necessary steps to understand female pain, it is impossible to expect them to address it, especially when female pain is often pushed to the back burner.
Many people measure the success of a c-section as whether or not a healthy baby is born, allowing this outcome to eclipse the comfort of mothers. Other procedures, such as fertility treatments, reflect the same trend: The outcome, a healthy baby, is placed over the experience of the mother. For example, a fertility clinic website reads: “…because our pregnancy rate is so exceptional we have chosen to stay with a technique that works.” While they do discuss the relative lack of pain experienced by the mother as a reason why their technique is special, it is clear that the final metric used to evaluate the efficacy of a procedure is the pregnancy rate. Women seeking fertility treatment are often willing to endure this pain due to their determination to become parents, but it is inexcusable that the medical system continuously asks them to do so. The acceptance of female pain in reproductive procedures could result from viewing women first and foremost as child bearers, as it is indicative that the presence of a baby is placed above the life of the woman herself. This disregard for pain extends to other procedures—such as the placement of IUDs—as well, suggesting that if a procedure is experienced uniquely by women, it is likely to be painful.
Women trust medical professionals, but that trust is not a two-way street. Female pain is often discounted due to cultural bias that paints women as emotional and hormonal. Consequently, the disregard of women’s pain is not isolated to procedures only experienced by women. When comparing the experience of women and men undergoing similar procedures, women in pain are more likely to receive sedatives, while men are more likely to receive pain relief prescriptions. This indicates that the medical field sees female pain as something to quiet rather than treat. During coronary artery bypass surgery, women are half as likely as men to receive painkillers. In the ER, women wait an average 65 minutes before receiving relief for acute abdominal pain, while men wait an average of only 49 minutes. In general, women receive lower levels of pain relief, illustrating a trend in which women are portrayed as dramatic instead of injured and too hormonal to be taken seriously.
Importantly, this discrepancy in pain relief measures is compounded by racial prejudices. In one study, those evaluating pain drastically underestimated the pain of women of color compared to all other groups. Moreover, people of color are less likely to receive care for their pain. For example, Black people are less likely to receive pain medication for bone fractures. Women of color are therefore left in a medical system where they face bias because of their gender and race.
The pain gap could be lessened through medical malpractice suits, but the dismissal of women has tainted the legal system as well. In order to win a medical malpractice suit, one must prove that what occurred is outside the scope of normal practice. In the US medical system, it has become normal practice to perform reproductive procedures without an adequate level of sedation or to dismiss female pain and provide women with lower levels of sedation. Therefore, when women experience extreme pain and attempt to take legal action, they face an uphill battle. If a woman received lower levels of pain relief medication because her physician thought her pain was due to hormonal or psychological issues, she would struggle to win a malpractice suit due to this sexist attitude being accepted as normal practice. The pain gap creates a situation where any experience of pain could be deemed to fall within this normal scope. Furthermore, women who explain their experience in medical malpractice suits are less likely to be believed, demonstrating how the dismissal of women extends far beyond the medical system and reflects a cultural attitude that also affects juries. To address this, society must be convinced that women deserve the same consideration and trust as men—a task which seems far too common.
Women trust medical professionals—realistically, they have no other choice—but the medical system needs to begin trusting women. Trust that the pain endured in female procedures is far too great, and that when women express their pain, it is real. If the staff at the Yale Fertility Clinic had trusted the cry of the women on the table, so much pain could have been avoided. She trusted the medical system, and it is time this trust is earned through research, the development of pain relief alternatives that work, or simply the same level treatment which is provided to men.