Levels of Pain
Updated: Jan 7
Patricia Gestoso ponders how the contempt for women’s pain justifies substandard healthcare for half of the humankind
Recently, I underwent a small surgery. I woke up in the operation room and I was asked for my level of pain from 1 to 10. I was puzzled by the question. Through the pain and the anesthesia fog, I searched for examples of past pain to rank it appropriately. Two memories came up.
Should I compare it to when I twisted my ankle in a badminton game during my Ph.D. studies in Canada? That was very painful. An 8. Definitely. That evening, I limped from the court to my home in the snow. I went to the university infirmary the next day. I was reassured – without X-rays to prove it – that I wouldn’t be able to walk if something was broken. I was referred to the site physiotherapist, who performed a rather painful 30 minute massage on my ankle. They booked me for a follow up session and I walked back to my home with resignation. After three days of limping back and forth between my home, the lab, and the supermarket, a work colleague with a car kindly offered to take me to the hospital. There, after begging – and covertly threatening – the doctor, I finally got my X-ray. The diagnosis? The physician, half amused half puzzled, shared that my fibula was fractured. I got a 6-week blue cast as a prize for my persistence.
Or maybe, I needed to compare it to my skull fracture in 2019. I fell during a teamwork activity on a Friday evening. That night and the subsequent days I experienced strong headaches. Unfortunately, I’ve been so well indoctrinated by this society to minimise my pain, that it was only the following Wednesday – when I felt my body shutting down – that I finally contacted the emergency services. Again, it took several calls to reassure my puzzled respondents that I was not messing around. Maybe concerned about a lawsuit, they finally sent me the ambulance. Again, I spent several hours moving from room to room and chair to gurney while numerous interlocutors tried to dissuade me that it couldn’t be so bad since I hadn’t called before. In the end, my perseverance won and I got an MRI reassuring us all that this ‘needy’ woman hadn’t wasted everybody’s time, but indeed, she had a small skull fracture. A 9 maybe?
Back to the operating room and my auto-assessment of my pain. I replied with a ‘six’. I got some analgesics. We waited. I was asked again if the pain had subsided. I said no. I was given codeine. We waited. I was asked again. I said it was still the same.
This was kind of inconvenient, they informed me. Because, if I was still requesting to alleviate my pain, that required that they give me morphine. And nurses in the ward were not going to appreciate the extra work. A silence followed. It was my turn to decide. Their intent gaze at me appeared to suggest that this was my cue to reconsider my initial answer: Was I so selfish that alleviating my pain was more important than the additional work for the nurses? Maybe it was not hurting so bad, after all.
In a moment of clarity – surely from a lifetime of learning that the only way to entitle my body to the care it deserves is perseverance – I replied that I wanted to be relieved from pain. I got my morphine and about 45 min later I was without pain. I don’t know how many angels I killed with my stubbornness, but it was worth it.
During my convalescence, in which unpleasant symptoms came and went, I reflected on my history with pain. For each time I’d fought back, there were plenty where I’d resigned myself to think ‘this too shall pass’. Like the shoulder problem that took a year and a half to fix itself, after both doctor and physiotherapist gave up, my pain not cooperating with their treatment.
Not all women's pain is the same
Society boxes female pain into three groups. First, we have the ‘because you’re worth it’ or perfection pain. An oxymoron. Perfection is ethereal, joyous, carefree, calmed, in control. Pain is real, demands action, it’s unrestrained, it’s political.
Perfection pain is driven by our ever-changing beauty standards. From fasting, miracle diets, and Botox all the way to anorexia, bulimia, and cosmetic surgery. Pain should be ignored as collateral damage in the worthy pursuit of beauty. It’s our duty as women to take care of our appearance. On the other side, it’s our fault if the pain doesn’t translate into the coveted photoshopped version of ourselves. Shame plastic surgery anyone?
Then, we have the proud pain. The fecundity pain: Childbirth and the loss of virginity. Curiously, as far as I remember, I’ve received contradictory messages about them. The most excruciating pain. The pain that makes you a woman. Both linked to rites of passage with blood and spectators ranking performance. This is the only female pain where bodily fluids are welcome.
As I don’t have children, my experiences of pain have often been minimised by health professionals and other women. Apparently, without experiencing birthing pain it’s impossible for me to correctly assess pain. My threshold is too low. I wonder if men are told the same.
That doesn’t mean it’s easier for mothers. The pain of women that do give birth is everybody’s business. Everyone has an opinion and feels entitled to police future mothers. Is it compatible to be a caring mother and refusing to undergo birthing pain? A lot of people think it isn’t. A relative of mine endured an exhausting and painful 23 hours of childbirth with her first baby. Upon learning about medical alternatives to reduce pain, next time she opted to be sedated, which reduces pain although still doesn’t remove the contraction pain. Still, she was reprimanded for her choice at the hospital for being selfish and only thinking about herself. This, even though the outcome was a healthy 4.350 kg baby boy! Other examples? When we force women in labour to wear face coverings. A survey conducted in the UK reported that nearly one in five pregnant women who gave birth in December 2020 were made to wear a face mask during childbirth, triggering feelings of claustrophobia, suffocation, and nausea.
Finally, we have the shame pain. This is inevitably linked to periods. Both to their presence and absence. I still remember the TAMPAX ads of the 80s. Women in white trousers smiling or in their Lycra jumping on the beach. How can you complain about your period pain if you’re only a tampon away from happiness? In fact, society ensures that we learn to downplay period pain to such a degree that women with endometriosis may endure excruciating pain for years under the perception that painful periods are ‘not worth mentioning’. A man taking a day off from work to recover from binge drinking after watching a football match? Boys will be boys. A woman taking a day off because of menstrual pain? The weaker sex.
And what do we talk about when periods are gone? Nothing. Until recently, menopause was ignored by Western societies, in spite of women spending an average of 20-35 years in that stage in their life.
Things are changing and we hear more about it. Which is great. Yet again, another excuse for women – and society – to police women. Natural remedies vs hormone replacement therapy (HRT). Those that tell us that it’s psychological vs the ones that swamp us with medical information and demand that women become our own doctors.
Unfortunately, there is much less flow of information regarding all the collateral conditions around menopause. Let’s take osteoporosis, a health condition that weakens bones, making them fragile and more likely to break. On average, women lose up to 10 percent of their bone mass in the first five years after menopause. What’s more, research suggests that about one in two women over the age of 60 will experience at least one fracture due to osteoporosis . Still, getting a £100 DXA or DEXA scan - the specialised X-ray technique that measures bone density – is a privilege you need to fight for in the UK. Apparently, it’s cheaper to wait for women to break their wrists, arms, and hips rather than monitor the density of their bones when they start undergoing menopause.
Those stories of beauty, childbirth, and shame pain have trained society and women to police our pain. We are quick to tell other women when it’s fine to experience pain, what’s the ‘right’ threshold and, more importantly, when they should minimise it. Otherwise, they better be prepared to receive an ‘it was worse for me’ reply. Or even better, ‘wait until you give birth’.
How are women going to be confident if we spent our lives having others disregarding and trivialising our experiences of pain? And if all attempts to dissuade women that they are experiencing pain fail, we’ll always have our brain to blame. Often, female physical pain has been attributed to mental problems – hysteria, madness, stupidity – or even better, personality traits of the bearer such as neediness and attention-seeking.
Some women are more equal
In my case, in addition to persistence – and the luxury to have the time to be persistent – I’m White. That means that I may be perceived as needy and whiny but I’m also regarded as delicate and fragile.
Other women don’t have that prerogative. For example, Black women. There is Serena Williams and her story about how she almost died giving birth to her daughter as a result of health professionals dismissing her symptoms. Unfortunately, there is a wealth of data about higher pregnancy mortality for Black women going back decades. Most of the reasons given for the ethnic divide try – yet again – putting the onus on women. Their weight, their socioeconomic status, their education…. the list goes on.
This is not a bug but a feature of the system. White people – including women – have largely benefited from assigning Black, and other non-White women groups, a different threshold for pain. Why do I say ‘benefitting’? Because if we recognise that Black and other non-White groups experience as much pain as White people, then we’ll need to acknowledge that historically we’ve attributed stereotypical super-human strength traits to those groups in order to ignore their suffering caused by the cruel Western colonizing practices.
Unfortunately, non-White women are not alone enduring double healthcare standards. Whilst public health authorities in the US record the use of contraceptives by women with disabilities, their pregnancies go under the radar and they don’t get standard maternity care. Wheelchair users may go their entire pregnancy without being weighted, they are disproportionately scheduled for C-sections, and decisions about their delivery are done without their input. This is compounded by the reluctance of obstetricians to agree to take care of them for fear of the additional complexity. And all that, in spite of research corroborating that women with and without disabilities want children to the same extent.
What if we didn’t neglect women’s pain?
What if we finally came to terms with the fact that women do experience pain and that this pain deserves attention?
We’d invest in endometriosis research at least as much as in baldness ($2 billion). In the US, the cost of endometriosis is estimated to be $119 billion but only $26 million of federal funding were approved for its research in 2020.
We’d put the money and the legal framework to ensure drug research is conducted disaggregating data by gender as well as other categories, such as ethnicity and age. The effect of a drug on a 25-year-old White man may greatly differ from a Latina in her 60s. We’d also fund medical research to specifically support trans and intersex collectives.
We’d stop making women pay for period painkillers. What’s more, we’d design painkillers specifically aimed to alleviate period pain, rather than prescriptions of the same drugs and doses used for toothaches and colds.
Finally, we’d plan for women’s overall health instead of ‘maintaining them alive’. Often, we hear that on average women live longer than men. What we don’t talk about is that women’s health during their life is consistently worse than men’s.
Still, if the status quo has not been profoundly changed by the COVID-19 pandemic, what will it take to stop ignoring the pain of 3.7 billion human beings?
Dr Patricia Gestoso is an inclusion strategist who helps leaders to leverage diversity to tap into new markets, boost revenue, increase reputation, and attract and retain talent. She has spearheaded several initiatives to promote diversity and inclusion in tech products and the workplace that were recognized with the UK 2020 Women in Tech Changemakers prize. She has conducted research on the effect of COVID-19 on the unpaid work of professional women and the factors accounting for the low representation of women in leadership positions in tech companies.
Find out more about her work at https://patriciagestoso.com/
Photo credits: High Frequency Electric Currents in Medicine and Dentistry, 1910, Public Domain Review