We need to talk about why women are expected to tolerate pain
Updated with new information from the CDC
Last year, I wrote about how painful IUD insertion can be, and the long-held related societal expectation that women tolerate all types of medical pain. After outcry about this issue on social media, women’s voices are finally being heard. Last month, the CDC issued new guidelines to doctors for IUD insertion, including the recommended use of local anesthetic lidocaine to reduce associated pain. That is because, in part, a CDC survey of physicians published in 2023 found a majority of doctors “routinely offered few pain relief options to their patients, except suggesting aspirin or ibuprofen before or during IUD placement.”
As always, women need to remain vigilant, speak up when something seems off or uncomfortable, and have a plan when they walk into their doctor’s office.
You can read more about the updated CDC recommendations here, and keep scrolling for my original post with tips on discussing pain with medical professionals.
I was at an event recently to discuss my gun safety activism; after my panel ended, a woman in the audience pulled me aside and motioned for me to lean in — she wanted to tell me a secret. Cupping her hand around her mouth so no one could read her lips, she whispered, “Thank you for talking about how much it hurts to get an IUD.”
This woman was just one of hundreds who reached out to me or commented after I posted on Instagram about how women are expected — and even encouraged — to tolerate medical pain. Clearly these women were looking for an outlet to discuss their own experiences with untreated pain, mostly from reproductive health procedures.
“I had a polypectomy, and it was absolutely awful. Awful,” one woman wrote. “I wept during the entire procedure. My OBGYN said they used to do it under anesthesia, but now they don’t anymore because ‘women seem to tolerate it.’ I cramped and bled for days and kept wondering what else women ‘seemed to tolerate.’”
This expectation isn’t in our imaginations. The Journal of the American Heart Association reports that women with chest pain wait 29 percent longer in ERs than men to be evaluated for possible heart attacks. Another analysis shows that women with acute abdominal pain are up to 25 percent less likely than men to be treated with painkillers. And, overall, women who experience pain are more likely than men to receive a sedative prescription instead of a pain medication prescription.
So it’s no surprise that 45 percent of women surveyed say they don’t think their healthcare providers take their pain seriously. And because women are more likely than men to express that they feel pain, women are often perceived to be overreacting.
“I asked my doctor to stop and give me a minute to deal with the pain of my IUD insertion and I was treated as noncompliant for pushing back,” one commenter wrote.
But research shows that women are actually more sensitive to pain than men. And even though numbing agents and local anesthetics are available for reproductive health procedures that can be painful, they’re rarely used.
“My IUD was so painful I passed out,” wrote one commenter. “I waited a half an hour before I felt good enough to drive home. I took the rest of the day off from work and laid in bed in a fetal position.”
Another wrote, “I had to have a uterine biopsy with no pain medication. I almost passed out. But I was never offered support or pain medication.”
“I was denied pain medication when I requested it during my last IUD removal/replacement, but then I found out there’s a numbing spray to address pain that women can be offered during any vaginal procedure,” wrote another.
And as is the case with most issues in America, the pain gap is even more severe for Black women due to white supremacy. Data shows many in the medical community erroneously believe Black patients have greater pain tolerance, which means Black women are less likely than white women to be diagnosed with endometriosis despite pelvic pain. And over 70 percent of Black women ages 18 to 49 say they’ve experienced at least one negative interaction with care providers, including dismissal of their pain.
“As a Black woman with several heart conditions, I can attest to the fact that when it comes to cardiovascular issues, we aren’t believed,” one woman commented on my post. “Not only are Black women not believed, but our pain is dismissed due to the myth that we have a higher pain tolerance.”
The misdiagnosis and mistreatment of women’s pain isn’t acceptable and it shouldn’t be tolerated. Here’s some advice from experts about how to learn more about pain management and how to discuss pain with medical professionals:
Create a plan with your doctor for pain management: If you’re having a procedure where you may feel discomfort before or after, have a frank conversation with your doctor about what the experience will feel like, the level of discomfort you may have, and your recovery timeline.
Bring a friend: Take someone with you to your appointment or procedure who understands your plan and can advocate for you. It can be difficult, and sometimes impossible, to advocate for yourself when you’re in pain or you've just undergone surgery.
Trust your gut: If something feels off, it usually is. One of the first clues is your vital signs. If your heart rate and blood pressure are rising during a procedure, for example, that should be a big sign to both the doctor and yourself that the pain you’re experiencing is out of the ordinary.
Speak up: Tell your doctor if you’re uncomfortable and they can, and should, adjust the treatment plan accordingly. Describe your experience as honestly as you can, without self-judgment, fear or embarrassment. You have the right to stop a procedure if you’re in pain.
Listen to the podcast “The Retrievals”: It chronicles what happened when about 200 women at a Yale fertility clinic underwent egg retrievals with insufficient pain relief because a nurse was stealing their pain medication from the clinic and replacing it with saline.
Watch the documentary “Below the Belt”: It follows four people on a years-long search for effective treatment for endometriosis and examines the problems in our healthcare system that disproportionately impacts women.
Keep talking about this issue: In the comments here, online, with your friends and definitely with your daughters. As one commenter wrote, “If we don’t share our stories, we all think ‘It’s just me who couldn’t handle the pain.”
As an 18-year-old, I underwent an endometrial biopsy with a local anesthetic that wore off while a resident tried 4X to get a sample. Eventually, he left to call the attending GYN out of surgery, and a nurse sat with me for more than 20 min while my legs shook uncontrollably. When the 70+ yr old GYN entered the room, hurriedly and annoyed, the nurse quickly loaded a syringe with more anesthetic. He said, "No need. This will only take a minute. If she's made it this far, she'll be fine." Women's Health is particularly cruel for women. It's almost as if living through our monthly pain and bleeding gives the false impression that we should be able to live through all other sources of pain and blood.
Thanks to my wife, I was made aware of how many OBGYN doctors are men, who can’t possibly understand what women experience, and often don’t care.