Women's pain and discomfort has a history of being ignored in health care. Here are 2 ways that's starting to change.

Two major developments in women's health have recently made news: less invasive alternatives to the pap smear — long considered “an uncomfortable but necessary evil” for cervical cancer screenings — and the new pain management guidelines for IUD insertion, the highly effective contraceptive that many women have said hurts when placed in the uterus to prevent pregnancy.

Women disproportionately experiencing pain in health care settings is nothing new. Research suggests they experience higher levels of pain and by larger margins on average than men, yet women’s discomfort is vastly undertreated and often ignored. Women in pain are more likely than men to receive prescriptions for sedatives instead of pain medication, and one study found that women who received coronary bypass surgery were half as likely to be prescribed painkillers as men who had the same procedure.

Why has women’s pain been dismissed for so long?

Women’s pain and discomfort in health care settings has long been ignored and misunderstood largely because women’s bodies and health have been misunderstood — going all the way back to the third century BCE philosopher Aristotle, who believed the female body was the inverse of men’s, with its genitalia “turn’d outside in.” As a result, the way women have traditionally been treated as patients often reflects old biases.

“The origins of the term hysterectomy pointed to a belief that ‘hysteria,’ a mental disorder of uncontrollable emotions, was specific to women and rooted in the uterus,” Beth Darnall, a clinical pain psychologist at Stanford University, tells Yahoo Life.

The propensity to blame women’s pain on emotion still happens in medicine today. The Washington Post reported on a study that found “middle-aged women with chest pain and other symptoms of heart disease were twice as likely to be diagnosed with a mental illness compared with men who had the same symptoms.”

David Thomas, special adviser to the director of the Office of Research on Women's Health, tells Yahoo Life: “Women are more often given anti-anxiety drugs for pain compared to men, where pain is dismissed as being of an emotional response. And unfortunately, not listening to women in clinical setting goes far beyond women reporting pain.”

Dr. Kristen MacKenzie, an assistant professor of anesthesiology at Stanford University, explains that mainstream culture has historically accepted that certain aspects of womanhood — like menstruation, childbirth and menopause — are inherently uncomfortable and that women have just been “dealing with it” for centuries.

“This creates the premise that if you are complaining about it, the problem is with your pain tolerance and not with the physical situation,” MacKenzie tells Yahoo Life.

Medicine also has a long history of not including women in studies to better understand their health. For example, under a 1977 policy (later rescinded in 1993) the Food and Drug Administration banned women of reproductive age from participating in early clinical trials — even if they were on contraception or had husbands who had vasectomies; the goal was to prevent fetuses from being exposed to experimental drugs, but the consequence was a shortage of data on how those drugs affect women.

“Historically, women’s health care has received less attention, research and funding, and that has impacted women’s health outcomes today — including how pain is measured, researched and treated,” Irene Aninye, chief science officer at the Society for Women’s Health Research (SWHR), tells Yahoo Life. “For a long time, women were not viewed as much different than tiny men when it came to their health” — meaning their pain was viewed as “a smaller version” of men’s pain — “so conclusions found for men were considered applicable to women as well. We now know these things to be false. There are important sex and gender differences when it comes to health and pain.”

How things are changing

In some ways, little has changed in women’s health care. The speculum hasn’t been updated much in 170 years and those forceps often used for IUD insertions and cervical exams, for example, were invented 135 years ago by French surgeon Samuel Pozzi, the so-called father of modern gynecology — and inspired by an American Civil-War era bullet extractor.

But experts say they’re seeing improvements in taking women’s symptoms and pain more seriously.

“There is greater awareness around biases in general, including gender biases, and a cultural movement toward equity,” Darnall says. “For instance, the National Institutes of Health requires that researchers include sex as a biologic variable in studies, ensuring we collect evidence on women and understand how to best meet their specific needs.”

She adds: "Having greater representation of female doctors may make a difference too. In the past year, 55% of medical students were women.”

Aninye says conditions that specifically impact women (like endometriosis and menopause) as well as ailments that disproportionately affect women (like migraines, which has twice the prevalence in women compared to men, and autoimmune diseases, with 80% of cases being diagnosed in women) are gaining more attention. But “there is still much work to be done to make these topics mainstream,” she says.

One challenge, experts say, is that pain is subjective and personal. Thomas says one area of research the NIH is focusing on is finding “objective measures of pain” to take some of the partiality out of treatment and diagnoses.

“It is hoped that objective measures of pain, rather than just things [like] a 0-10 scale, could reinforce that people are in pain, what type of pain they have and suggest potential treatments,” Thomas says. “While the patient voice is too often ignored or dismissed, our hope is that hard scientific data will be impossible to ignore.”

What can women do to be heard?

Experts offer these tips for discussing pain or discomfort — or raising other health concerns with medical professionals.

• Find a doctor you trust. Seek health care advice and treatment from someone you believe will be empathetic and understanding of any concerns you might have. “Patients need to find a clinician they trust — either based on their own prior experiences with that clinician or based on trusted recommendations,” says Dr. Paula Castaño, an associate professor of reproductive health at Columbia University.

• Ask questions. MacKenzie says it’s helpful to bring a list of specific questions to medical appointments, and to tell your provider in advance that you’d like to go over that list with them. “Many patients have a worry about a specific missed diagnosis, and they should feel empowered to bring that up to their provider so they can get a clear resolution or a referral to a sub-specialist,” she says. And if you’re considering a medical procedure, ask the clinician about any pain you might experience and any pain management that’s available.

• Bring an advocate. “Because medical visits can be intimidating or overwhelming, I also encourage patients to bring along a trusted friend or family member to help ask questions and advocate for them,” Castaño says.

• Keep calm. If your concerns are brushed aside, be persistent. “Feeling dismissed can create frustration,” Darnall says. “It’s best to remain calm and restate your primary question or issue. Request more information so you can understand the treatment plan and your options.”

• Seek a second opinion. If your current provider isn’t answering your questions or giving you the information you need, find one who will listen to your concerns. “As a patient, you are entitled to as much information as it takes for you to feel comfortable with your health care decisions,” Aninye says. “Unfortunately, it is not uncommon for many women to have to visit several [providers] before receiving an accurate diagnosis or solidifying an effective treatment plan for their condition.”

• Share your story. MacKenzie says that women sharing their experiences on social media raises awareness in both the general public and among medical providers, and is already leading to change. “Women deserve to have these conversations with their health care provider without the expectation that they should suffer simply because women suffered with these symptoms before them,” she says. Aninye agrees: “Sharing first-hand accounts can lead to powerful connections and be real agents of change in health care, research and policy. Women should share their health stories where and when they feel comfortable. Speaking out can improve awareness of women’s health and even influence research and funding decisions.”