There is also mounting evidence that men and women may experience pain differently. A woman’s pain sensitivity increases and decreases throughout her menstrual cycle, ‘with skin, subcutaneous tissue, and muscles being affected differently by female hormonal fluctuations’.73 An animal study which found that males and females use different types of immune cells to convey pain signals may provide the beginnings of an answer as to why74 – although only the beginnings: sex differences in pain remain an underresearched area and even what we do know is not widely dispersed. Dr Beverly Collett, who until she retired in 2015 was a consultant at Leicester’s pain management service and chair of the Chronic Pain Policy Coalition, told the Independent that the average GP ‘has no idea that drugs such as paracetamol and morphine work differently in women’.75
Even if they are treated for their pain, women routinely have to wait longer than men to receive that treatment. A US analysis of 92,000 emergency-room visits between 1997 and 2004 found women had longer waiting times than men,76 and a study of adults who presented to a US urban emergency department between April 2004 and January 2005 found that while men and women presented with similar levels of pain, women were less likely to receive analgesia and women who did receive analgesia waited longer to receive it.77 A US Institute of Medicine publication on chronic pain released in 2011 suggested that not much has changed, reporting that women in pain face ‘delays in correct diagnosis, improper and unproven treatments’, and ‘neglect, dismissal and discrimination’ from the healthcare system.78 In Sweden a woman suffering from a heart attack will wait one hour longer than a man from the onset of pain to arrival at a hospital, will get lower priority when waiting for an ambulance, and will wait twenty minutes longer to be seen at the hospital.79
The reality that female bodies are simply not afforded the same level of medical attention as male bodies is often brushed aside with the riposte that, on average, women enjoy more years of life than men. But while it is true that female life expectancy remains a few years longer than male life expectancy (although that gap is narrowing as women’s lives have become less prescriptive and occupational safety in male-dominated jobs has become more stringent), there is evidence to suggest that the female mortality advantage isn’t exactly secure.
A 2013 paper that examined trends in US mortality rates from 1992-2006 in 3,140 counties reported that even as mortality decreased in most counties, female mortality increased in 42.8% of them.80 And while men’s years of good health have increased in line with their longevity, both women’s longevity and active years have increased at a much lower rate: thirty years of US health data showed that, while women live on average five years longer than men (in Europe it is 3.5 years81), those years are spent in ill health and disability.82
The result is that US women no longer have more active years than men,83 despite their longer lives, and while women account for 57% of US citizens aged over sixty-five, they make up 68% of those who need daily assistance.84 In 1982 both men and women who lived to eighty-five could expect two and half further years of active healthy life. For women, that figure hasn’t changed, but an eighty-five-year-old man alive now can expect to be active and healthy until he’s eighty-nine. The trend of increasing longevity and good health amongst men can also be found in Belgium85 and Japan.86 A WHO paper into women’s health in the EU reported that in 2013, ‘even in countries with some of the highest overall life expectancy in the Region, women spent almost 12 years of their life in ill health’.87 And, yes, it would be nice to have some sex-disaggregated data on why this is happening.
A particularly troubling side effect of Yentl syndrome is that when it comes to medical issues that mainly or only affect women, you can forget about including women in trials because here the research is often lacking altogether.
Premenstrual syndrome (PMS) is a collection of symptoms that can include among other things: mood swings, anxiety, breast tenderness, bloating, acne, headaches, stomach pain and sleep problems. PMS affects 90% of women, but is chronically under-studied: one research round-up found five times as many studies on erectile dysfunction than on PMS.88 And yet while a range of medication exists to treat erectile dysfunction89 there is very little available for women, to the extent that over 40% of women who have PMS don’t respond to treatments currently available. Sufferers are still sometimes treated with hysterectomies; in extreme cases, women have tried to kill themselves.90 But researchers are still being turned down for research grants on the basis that ‘PMS does not actually exist’.91
Period pain – dysmenorrhea – similarly affects up to 90% of women,92 and according to the American Academy of Family Physicians it affects the daily life of around one in five women.93The level of pain women experience on a monthly basis has been described as ‘almost as bad as a heart attack’.94 But despite how common it is and how bad the pain can be, there is precious little that doctors can or will do for you. A rare 2007 grant application for research into primary dysmenorrhea described its causes as ‘poorly understood’ and treatment options as ‘limited’.95 The prescription medications which are available have serious possible side effects and are by no means universally effective.
When I went to my (male) doctor about period pain that wakes me up at night and leaves me in a moaning foetal position in the daytime, he more or less laughed me out of the room. I haven’t bothered trying again. So imagine my joy when I read about a 2013 study that seemed to have
