This article was originally published in our Spring 2021 print issue.

Women who suffer from severe abdominal pain have to wait, on average, 65 minutes in the ER to receive care. Men, on the other hand, only have to wait 49 minutes. Often women who come in with abdominal pain, even when admitted to the ER, are seven times more likely to be misdiagnosed. One of the most misdiagnosed diseases, primarily due to a poor understanding of women’s pain levels, is endometriosis. Endometriosis affects around 10% of women above or at reproductive age. Dr. Kathy Huang, a Gynecologist at NYU Langone, says endometriosis is often misdiagnosed for many diseases, from urinary tract infections to weight-related hormonal issues. In one instance, a woman was criticized for claiming to have endometriosis and was told to stop being a google doctor. A deeper understanding of the public health issue behind endometriosis — a condition characterized by uterine tissue growth outside of the uterus — indicates that the primary reason for misdiagnosis and negligence is a poor understanding of women’s pain levels and a lack of awareness. 

According to a study done by the American Medical Association’s Journal of Ethics, women may be more susceptible to pain than their male counterparts due to numerous biological and hormonal differences. Hence, due to them being more attuned to their pain tolerance, they are more likely to seek treatment for their pain. According to Dr. Mike Fox, a Florida Board of Medicine certified Endocrinologist, the problem is that male and some female physicians often mistake women’s pain to be an emotional response to external or internal stimuli. Hence, when a woman comes into the ER reporting abdominal pain, many doctors internally decrease the amount of pain they think the women are going through. On the other hand, people also see women as having higher pain tolerances. This belief is rooted in several physicians believing that since women go through pain (menstrual cycles, labor, etc.) and do not continuously complain about it, they must have higher tolerances than men. Therefore, women who stray away from this norm tend to disorient physicians away from their inert understandings. Hence, women who report pain, even though they do it more than men, are said to be “anxious.”

Endometriosis is a good example of an often misdiagnosed and misunderstood disease. An early diagnosis can, in many cases, lead to better pain management. Therefore, a better understanding of pain, combined with an increase in awareness amongst the general public for illnesses like endometriosis, polycystic ovary syndrome, lipoedema, etc., can help provide care to women before the conditions reach a more severe stage. However, many obstacles are standing in the way of a quick diagnosis. First of all, women experience a plethora of different symptoms. Some women suffer from depression, pelvic pain, anxiety, and high blood pressure, while others have abdominal pain, irregular menses, and cannot walk for months due to pelvic pain. If a health professional suspects that someone may have the disease, they can perform a pelvic exam, a laparoscopy, or a transvaginal ultrasound. Unfortunately, for most women, pelvic exams are not diagnostic enough to confirm endometriosis; laparoscopy and transvaginal ultrasounds are only done in extreme cases as they are expensive. Therefore, there is a significant lag in diagnosis, leading to a painful progression of disease and symptoms. As a result, doctors are resistant to diagnosing endometriosis and will often look at alternative disease, ignoring the pain and pleas of many women. 

Endometriosis is not a small-scale, individual problem. Rather, it is a public health issue. According to Dr. Fox, not only is endometriosis physically taxing, but it also has both enormous economic and social impacts. 50% of women who suffer from the disease stay home during their menstrual period every month. For women earning hourly wages, this can increase the difficulty of making ends meet. Meanwhile, salaried women may be overlooked for managerial positions due to their monthly absences. Many women with endometriosis are forced to frequent gynecology offices, leading to 2.6 million dollars being spent annually by patients to relieve symptoms such as abdominal pain, irregular bleeding, increased blood pressure, etc. This places patients who have endometriosis at an economic disadvantage. Furthermore, in severe disease cases, women are given hysterectomies: a potentially harmful procedure as it causes premature menopause and speeds up aging. This leads to several mental (depression, anxiety, etc.) and physical (hot flashes, pain, etc.) side effects. While hysterectomies stop women from having periods, the severe perturbations to the hormonal cycles can lead to many abnormalities such as elevated blood pressure and urinary tract infections. Additionally, complete recovery may take up to 2 months, further affecting the patient’s work life. 

Many steps can be taken at a public health stage to help aid diagnosis at an earlier stage. Increasing awareness and funding for the illness can improve research behind better diagnostic measures. Increased insurance coverage or access to birth control can also decrease the buildup of endometrial tissue. Additionally, standing against misinformation and raising physician understanding on pain tolerance can help women suffering from endometriosis. According to Dr. Huang, increased training on pain detection, willingness to listen to patient narratives, and frequent bias testing may help fight against the misdiagnosis of endometriosis and other painful disorders. 

Funding, awareness, and a more nuanced pain measurement scale can help fight against severe pain disorders for both men and women. Doctors need to make sure that their patients’ minor pain concerns are being heard and managed. Instead of dismissing patient concerns based on gender stereotypes, we should attempt to build a more nuanced understanding of illness and suffering. Diseases impact all aspects of life, from a person’s physical to their economic well-being. Hence, it is crucial to continuously update and improve our understanding of diagnosis, symptoms, and disease.