Imagine a world where there is no pain. It’s hard to do right? Pain encompasses so much of the human experience; emotional, physical, and everything in between. It’s a powerful indicator. Physically, it tells us when something is wrong. So, pain should be listened to, I mean, there’s a reason why Aldous Huxley’s ‘painless’ Brave New World is ‘dystopian’. 

However, in our society only some pain is listened to, only some pain is recognised. The Gender Pain Gap (GPG) is an example of this, and it paints a backdrop for modern day dystopia. 

Dr Carrie Purcell, lead on the Open University’s new ‘Gender Pain Gap study’, defines GPG as “the difference in the way pain is recognised, understood, and managed that differs by gender. Women’s pain in particular is under acknowledged, under treated, and not well understood in various different areas of health”.

In our society pain still exists but, akin to Huxley’s class separation, our pain separates gender. However, there seems to be another gap emerging within this, which is the continued dismissal of reproductive specific pain.

Hannah’s experience represents one of the many. 

Hannah’s story:

Hannah Oldman, 51 has lived in pain throughout her entire adult life.

“It felt like being stabbed consistently over and over again. It would come in waves, but it was never not there” she says.

“At the worst moments, I would be on the floor. I couldn’t get up, and I was wailing, involuntary wailing because I was in so much pain. You can’t have any sort of normal life when it’s like that.”

This chronic pain started when she was a teenager, after countless medical appointments and she was given the contraceptive pill to help with the pain. There was no further exploration into her symptoms or the actual cause, the underlying issues seemingly swept under the rug. It was only at 31 years old that she was diagnosed with Fibroids. 

Fibroids is a condition that means non-cancerous growths form around the womb, according to the NHS 2 in 3 women will develop at least one fibroid growth within their lifetime.

“In my 30s I was told that I can no longer be on the pill, it was never explained to me why. They just said, you’re too old now,” she continues. 

“Immediately my very painful periods came back, and they just got worse and worse, having it suddenly back in my life was just horrible. It dominates everything. There would be a couple of days, at least every month, that I couldn’t really leave the house because of just debilitating pain.”

“It dominates everything.”

A common theme that came through in my conversation with Hannah was this sense of being left in the dark. For example, theres is no reason why a woman should be deemed ‘too old’ by the age of 30 to be on the contraceptive pill, unless there were underlying issues – if this was the case she was not informed. There seemed to be nothing being done to dig into why she was experiencing such excruciating pain and no effort to truly solve it.

Gaby Coia, a sexual health nurse, explains how this could be to do with the current priority to identify cancers. 

“I see some terrible things in general practice, such neglect of women’s health, by both male and female clinicians” she says.

“It’s drummed into us that everyone is a potential walking cancer. 

“As a result there’s a lot less time spent on women’s health unless it’s related to cancer.”

This is no surprise when less than 2% of funding for medical research goes towards female reproductive health, childbirth and pregnancy, as the Imperial College London found. This coupled with the strain on the NHS is causing increased waiting times and a lack of appointments.

Hannah herself experienced this when she was given the option of a hysterectomy later on in her 30s, until this point no real pain management had been implemented.

“I didn’t want to completely give up on having children, but it was the only real option given to me. It was kind of put to me in a way that was like, well, you don’t want it? 

“Well, the pain can’t be that bad then. If you’re in real pain then you’d take the hysterectomy. That’s how it felt,” she says.

In a sense, she was offered an ultimatum: pain and children, or no pain and no children. 

Last year she chose to go ahead with the hysterectomy but even after surgery she was still experiencing pain. 

“I feel like I’m back at square one,” she admits.

“I’m back to hustling to get that checked out. I don’t have ovarian cancer, which is good, but because they ruled that out, then it’s like, okay, we’re done. That’s felt consistent throughout this whole process.

“Once they decide it’s not cancer, it feels like they go okay, we’re good, you don’t have cancer, and take a step back, but I’m still left with excruciating pain.”

Reproductive stigma

Around the same time of her eventual fibroids diagnosis, Hannah was also diagnosed with rheumatoid arthritis and the comparison in treatment across the two is alarming.

“With my arthritis, I automatically have an appointment every six months, and if I’m having a particular pain, I can get an appointment pretty much straight away. 

“The staff know me, and my medication is monitored very well” she explains.

“There was nothing like that with the fibroids, there was no consistency, I wasn’t even seeing the same doctor.

“I would push and push for another appointment, and if I was given one they would go, you still have fibroids, you’re still bleeding heavily, you’re still in pain, what else do you have to report? 

“I just wanted something done about it”, she recounts, her frustration evident.

“I’m vocal, I was hassling, but still I couldn’t get anything done.”

More recently, Hannah suffered with a burst abscess in her bowel, and again the contrast in treatment was stark. 

“It was nothing compared to the pain I had with the fibroids, yet, the second I went to hospital they put me straight on morphine. 

“The level of pain was taken so seriously, but you know, I was never given morphine for my fibroids,” she says.

When looking back to the correlation to Brave New World, procreation is this lewd concept that citizens have been conditioned to think is taboo and abnormal. This parallels the way in which western medicine has created a system that refuses to acknowledge women’s reproductive health conditions as real issues, conditions the idea that they don’t cause levels of pain they deem acceptable of an issue. 

“It’s a cliche, but, if men were in that much pain. Oh my god, It would be sorted in 48 hours!” she adds in a burst of annoyance, but, is it such a cliche? 

“It’s a cliche, but, if men were in that much pain. Oh my god, It would be sorted in 48 hours!”

Why, like Hannah, is women’s reproductive pain seen as inferior to other conditions, and something that can be brushed to one side? To get a better understanding of this I spoke further with Dr Carrie Purcell.

“The root cause comes down to a quite deeply ingrained patriarchal model, which makes up the foundations of modern medicine, and western healthcare. 

“Western medicine is based on the idea that male bodies, and the way they function, are the norm. 

“So then, female bodies and the way they differ to male bodies are kind of pathological, so they’re not normal,” she explains.

Dr Purcell explains that this historical lack of importance and understanding towards the female body continues to have a strong influence over what is seen as ‘acceptable’ levels of pain.

A study by Harvard Health further found that 80% of pain trials are conducted on men or male mice, so its clear to see how women’s reproductive specific pain could ‘slip through the gaps’.

In the UK this ideology is prominent, as the Government last summer stated that a ‘male as default’ approach currently exists in recent women’s health strategy. Therefore, pain stemming from reproductive issues, specifically, hold little precedence over the wider medical stage, I mean, why would it if the female body isn’t even acknowledged as ‘normal’?

So, how do we fix this?

So, It’s fair to say we’re not in a pain free world, but, there are more parallels to Huxley’s world than first thought. It’s clear that pain related to women’s reproductive health is a massively under acknowledged area of medicine, and the issue runs deep. This reproductive gap is ingrained and exacerbated by the very building blocks that modern medicine is built on. The male as default approach never has, and never will, cut it, and without medical reform this dystopian loop of injustice will continue to haunt women for generations. 

More research and cultural acknowledgment is needed as both Dr Purcell and Gaby highlighted. Research needs to be properly funded and implemented, to pave the way for improved training standards and guidelines that allow clinicians to safely prescribe new forms of pain medication, so women are not given one extreme ultimatum after years of neglect, like Hannah was. 

Hannah’s pain deserves to be recognised, your pain deserves to be recognised.